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)

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.

J. Ghosn1, A. Delobelle2, M. Leruez-Ville3, C. Beaudoux2, L. Mascard3, A. Canestri4, R. Landman5, D. Zucman6, D. Ponscarme7, A. Rami8, J.-P. Viard1, B. Spire9, H. Lecuyer10, D. Costagliola2, C. Rouzioux3, M. Suzan-Monti9
1Hopital Hotel Dieu de Paris, Unité Fonctionnelle de Thérapeutique en Immuno-Infectiologie, Paris, France, 2INSERM UPMC UMR S943, Paris, France, 3CHU Necker Enfants Malades, Virologie, Paris, France, 4CHU Bicetre, Le Kremlin Bicetre, France, 5CHU Bichat, Paris, France, 6Hopital Foch, Suresnes, France, 7CHU Saint Louis, Paris, France, 8CHU Lariboisière, Paris, France, 9INSERM UMR S912, Marseille, France, 10CHU Necker Enfants Malades, Bactériologie, Paris, France