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TheBody.com/TheBodyPRO.com covers The 52nd Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC 2012)

Even HIV-Infected Men With Undetectable HIV in Blood May Shed HIV in Semen

October 11, 2012

HIV-infected men on antiretroviral therapy sometimes still shed HIV RNA in their semen even if they have suppressed levels of HIV RNA in their blood plasma and no symptoms of other sexually transmitted diseases, according to the first-ever longitudinal study to examine the phenomenon in that population. The study was presented at ICAAC 2012.

Most of the previously available data on this topic are from cross-sectional studies with a small sample size, and concern only heterosexual men involved in medically assisted reproduction programs, according to the French research team led by Jade Ghosn, Ph.D., of the Bicetre Hospital in Paris.

In the study, researchers analyzed data from 157 HIV-infected patients, all of whom had blood plasma HIV volume of less than 50 copies/mL for at least six months. The participants ranged in age from 27 to 67, with a median age of 44. All of the participants declared themselves to be men who have sex with men (MSM). The median time since HIV diagnosis was 10.4 years, ranging from 0.8 years to 26.3 years. The participants agreed to a 48-hour period of sexual abstinence prior to sample collection.

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A total of two seminal and plasma samples were collected one month apart. HIV RNA was detected in 23 out of 304 sperm samples, or 7.6% of samples. In two patients, RNA was found in both samples; in 14 patients, it was found only in the second sample; and in five patients, it was detected only in the first sample.

While those with a higher level of HIV DNA in the intracellular reservoir were 3.1 times likelier to shed RNA, even those with lower HIV DNA still sometimes shed HIV RNA in their semen, according to the study. Still, the researchers said that the study also showed, for the first time, that the size of blood HIV-1 reservoir predicts the detection of HIV RNA in the sperm.

The phenomenon of seminal HIV shedding despite apparent viral suppression in blood plasma occurred almost twice as frequently in MSM compared than among heterosexual men, the researchers said. The 7.6% rate among MSM found in this study far exceeded the 3.1% reported among heterosexual men in a study by Sidonie Lambert-Niclot, Pharm.D., Ph.D., et al, published in the journal AIDS earlier this year. (The P value for this comparison was 0.016.)

Of the patient population, 20.5%, or 32 patients, had an asymptomatic sexually transmitted disease (STI), including six cases of syphilis, 18 cases of ureaplasma urealyticum and three cases of chlamydia.

There was no association between seminal HIV RNA shedding and other factors, such as STI, HIV disease stage, nadir or current CD4 count, or duration of blood plasma HIV undetectability, according to the study.

It is not yet known whether or not the low seminal HIV RNA levels found in this study are high enough to make the virus transmissible, the study poster said. Among study participants, the median number of casual partners in the last three months was 10, with a range between 1 and 160. Of participants, 99 had a stable partner, but 62 of those reported that the partner had had casual encounters during the last three months.




 


Reader Comments:

Comment by: fogcityjohn (San Francisco, CA) Fri., Oct. 19, 2012 at 12:05 am EDT
What stuns me about this article is the fact that it reports that, based on two different studies, there's a difference in the rate of shedding between MSM and heterosexual men, but it says absolutely nothing about those findings. I can understand that the researchers may not know why there's a difference, but I would have thought there would at least be some comment on the discrepancy. Could it be random? Is it due to differences in study composition? Or perhaps to difference in study size? It would be good to hear more about this.
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Replies to this comment:
Comment by: Myles Helfand (TheBody.com) Wed., Oct. 24, 2012 at 7:56 pm EDT
No idea, FCJ. Other reports on this study haven't explored that question either, and the author's attempts to contact the researchers for the study were unsuccessful. This may be a case where we need more/better/bigger research to help see whether there's really a difference there, or whether the apparent difference was really just a quirk of the way these two studies were designed.


Comment by: Z (Washington, DC) Wed., Oct. 17, 2012 at 8:27 am EDT
As a layperson unfamiliar with testing protocols, I'm fascinated by the statement "HIV DNA in the intracellular reservoir". How is this measured?

Thanks!
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Comment by: michael (los angeles) Sat., Oct. 13, 2012 at 6:28 am EDT
so....did they follow up a viral load test after the samples were taken to make sure that those patients remained undetectable? or where the viral loads taken just prior to the collection of samples?

also curious to know the CD4 levels of each of these patients.......especially those who shoed signs of hiv rna in their semen.....correlating that maybe a reconstituted immune system helped keep the semen clear of the virus, and not just the medicine trying to prevent the virus from replicating and those hiv rna could be the result of a sputtering immune response due to a weaker immune system compared to the rest.........surely an undetectable man with an 800 CD4 count would have a better management of the virus than an undetectable man with a 50 CD4 count?
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Please note: Knowledge about HIV changes rapidly. Note the date of this summary's publication, and before treating patients or employing any therapies described in these materials, verify all information independently. If you are a patient, please consult a doctor or other medical professional before acting on any of the information presented in this summary. For a complete listing of our most recent conference coverage, click here.

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