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Detectable HIV May Be in Semen Despite Viral Suppression in Blood

August 1, 2013

HIV can still be detected in the semen of some HIV-infected men, even if they are on sustained antiretroviral therapy and have an undetectable viral load in their blood, according to a study presented at IAS 2013.

The study, conducted by French researchers and led by Jade Ghosn, Ph.D., followed 157 HIV-infected men who have sex with men (MSM), all of whom were on treatment, had a blood plasma viral load below 50 copies/mL and had no symptoms of other sexually transmitted infections (STIs).

The researchers found that 7.6% of the MSM had detectable (over 50 copies/mL) amounts of HIV in their semen. This finding was based on analyses of semen samples collected at baseline and at 4 weeks. HIV was detected in 23 out of 304 semen samples, with a median seminal plasma viral load of 145 copies/mL.

The median age of the participants was 44, with a median CD4+ cell count of 637. The median time on treatment at baseline was 6.6 years and the median time with an undetectable viral load was 3.3 years.

After performing a multivariate analysis, the researchers found no association between seminal viral load and STI, nadir or current CD4+ cell count, duration of undetectable blood viral load, adherence to treatment or number of sexual partners.

However, having HIV DNA in the peripheral blood mononuclear cells (PBMCs) above 318 copies per million cells made it 3.1 times more likely for a study participant to have detectable virus in his semen.

Also worth noting: The 7.6% rate for MSM was much higher than the 3.1% rate found in a study of heterosexual men conducted by Sidonie Lambert-Niclot, Pharm.D., Ph.D., and her team, but the researchers did not have data to explain why this difference may be.

These findings were also previously presented at ICAAC 2012.

View the full study poster.

Warren Tong is the research editor for and

Follow Warren on Twitter: @WarrenAtTheBody.

Copyright © 2013 Remedy Health Media, LLC. All rights reserved.


Reader Comments:

Comment by: Bob Leahy (Toronto) Sun., Oct. 6, 2013 at 4:45 pm UTC
Without any comment or explanation as to the impact of such low levels of virus in the semen, where they occur at all, on the ability of the infected person to transmit the virus, this is "science" reporting of limited use. Prevention workers have long used the semen bugaboo to scare undetectable folks in to using condoms even though the cases of transmission from people with undetectable viral load are next to nil. It's hard not to conclude the occasional incidence of low level virus in the semen is of little consequence, even though the threshold viral load is somewhat unclear, but it's almost certainly more than the median level of 145 copies reported here. (If some semen samples where the VL was undetectable in the blood recorded over, say, 10,000 copies in the semen we perhaps need to take more notice but there's no indication of that here.

To argue that people with undetectable viral load may still be infectious because of this semen issue, as is routinely argued by prevention people, seems unsupported by the science, unnecessarily stigmatizing and requires to be challenged each and every time this red herring is trotted out. And yes, I agree with the other comments. Let's stop funding this kind of research. It's just an irrelevant distraction.
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Comment by: Tom Wed., Aug. 14, 2013 at 11:56 am UTC
"Might be time to do a large study and get some answers as to what undetectable really means!"

Undetectable still means unable to be detected, not eradicated, and almost always uninfectious, just like it meant before we started doing all these stupid seminal viral load studies. Please, for the love of god, can we stop funding stigma and calling it science?
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Comment by: dick keiser (fort lauderdale) Wed., Aug. 14, 2013 at 8:39 am UTC
So does this really mean anything? He doesn't state what the highest value of HIV was in the semen only median viral load of 145 which is still low. Sample size of 157 and researcher states that results were different in this sample than in heterosexuals?

My understanding it has been known for years that HIV levels in the semen may be different because it is costly to do a semen test routinely and it was not considered important. Might be time to do a large study and get some answers as to what undetectable really means!

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