Share Abstract
HIV shedding in semen of men who have sex with men on efficient cART is associated with high HIV-DNA levels in PBMC but not with residual HIV-RNA viremia (ANRS EP49)
Abstract Content:
Background: Few data exist on the efficacy of combined antiretroviral therapy (cART) in semen of HIV-1 infected men who have sex with men (MSM) with a sustained control of HIV replication in blood.
Methods: HIV-1 infected MSM on stable successful cART with no sign of sexually transmitted infection (STI) were enrolled. Seminal plasma HIV-RNA (spVL) and blood plasma HIV-RNA (bpVL) were quantified from two paired samples collected one month apart. Relationship between spVL and residual HIV-RNA in blood plasma (measured by ultrasensitive assay, LOQ 5 copies/ml), intracellular total HIV-DNA in PBMC, TPHA/VDRL, sperm culture and seminal HSV-2 DNA was assessed using a GEE logistic regression accounting for repeated sampling in the same individual.
Results: 157 patients (pts) were included. Median time with bpVL < 50 copies/ml was 3.3 years, median current CD4 cell count 637/mm3 and median number of sexual partners during the last 12 weeks was 10. At inclusion, all had bpVL< 50 cp/ml for at least 6 months. spVL was detectable in 23/304 samples, yielding a prevalence of 7.6%. Median spVL was 145 cp/ml (50-1475). spVL was detectable on the first sample in five pts, on the second sample in 14 pts and on both samples in two pts. 32 pts (20.5%) had asymptomatic STIs: syphilis (6), G. vaginalis (4), U. urealyticum (18), N. gonorrhoeae (2), mycoplasma (1), C. trachomatis (3). HSV-2 DNA was negative in all semen samples. Residual HIV-RNA in blood plasma was undetectable by ultrasensitive assay in 225/304 samples (74%). There was no association between spVL and STI, CDC stage, nadir or current CD4, duration of bpVL undetectability, residual HIV-RNA in blood plasma, number of sexual partners in the last 12 weeks. Intracellular PBMC HIV-DNA predicted significantly spVL detection (OR (IC95%) 3.1 (1.2-7.7) for HIV-DNA>2.5 log10 cp/106PBMC).
Conclusion: This is the first longitudinal study focusing on HIV MSM with supressed bpVL and no symptom of STI. We show that HIV-RNA can be detected in semen of HIV-1 infected MSM despite successful cART, with a higher prevalence than previously published in heterosexual men. The size of blood HIV-1 reservoir predicts spVL detection.
Methods: HIV-1 infected MSM on stable successful cART with no sign of sexually transmitted infection (STI) were enrolled. Seminal plasma HIV-RNA (spVL) and blood plasma HIV-RNA (bpVL) were quantified from two paired samples collected one month apart. Relationship between spVL and residual HIV-RNA in blood plasma (measured by ultrasensitive assay, LOQ 5 copies/ml), intracellular total HIV-DNA in PBMC, TPHA/VDRL, sperm culture and seminal HSV-2 DNA was assessed using a GEE logistic regression accounting for repeated sampling in the same individual.
Results: 157 patients (pts) were included. Median time with bpVL < 50 copies/ml was 3.3 years, median current CD4 cell count 637/mm3 and median number of sexual partners during the last 12 weeks was 10. At inclusion, all had bpVL< 50 cp/ml for at least 6 months. spVL was detectable in 23/304 samples, yielding a prevalence of 7.6%. Median spVL was 145 cp/ml (50-1475). spVL was detectable on the first sample in five pts, on the second sample in 14 pts and on both samples in two pts. 32 pts (20.5%) had asymptomatic STIs: syphilis (6), G. vaginalis (4), U. urealyticum (18), N. gonorrhoeae (2), mycoplasma (1), C. trachomatis (3). HSV-2 DNA was negative in all semen samples. Residual HIV-RNA in blood plasma was undetectable by ultrasensitive assay in 225/304 samples (74%). There was no association between spVL and STI, CDC stage, nadir or current CD4, duration of bpVL undetectability, residual HIV-RNA in blood plasma, number of sexual partners in the last 12 weeks. Intracellular PBMC HIV-DNA predicted significantly spVL detection (OR (IC95%) 3.1 (1.2-7.7) for HIV-DNA>2.5 log10 cp/106PBMC).
Conclusion: This is the first longitudinal study focusing on HIV MSM with supressed bpVL and no symptom of STI. We show that HIV-RNA can be detected in semen of HIV-1 infected MSM despite successful cART, with a higher prevalence than previously published in heterosexual men. The size of blood HIV-1 reservoir predicts spVL detection.