Persistence of human immunodeficiency virus in semen after adding indinavir to combination antiretroviral therapy

Changes in human immunodeficiency virus (HIV) type 1 concentration and prot ease genotype were evaluated in semen specimens from 22 HN-positive men bef ore and 6 months after the addition of indinavir to dual nucleoside therapy . Seminal HIV was detected by polymerase chain reaction analysis for DNA or RNA for 59% of men before combination treatment and persisted at 6 months for 31% of the men who initially had seminal HIV detected (P = .026). The m aximum levels of cell-free RNA, cell-associated RNA, and proviral DNA in se men before treatment and at 6 months were 400,000 and 10,000 copies/mL, 70, 000 and 27,000 copies/mL, and 80,000 and 3,000 copies/mL, respectively. Thr ee of the four men with persistent seminal DNA had plasma viral loads of >1 0,000 copies/mL before treatment. One patient who became intolerant to indi navir had seminal HN RNA detected by PCR analysis after 6 months. Although none of the cultures of semen specimens from the four men with PCR analysis -detectable seminal DNA after 6 months yielded HIV, indinavir resistance mu tations were identified in a seminal leukocyte DNA specimen from one patien t, and a second patient whose therapy was switched to saquinavir had differ ent protease inhibitor resistance mutations in seminal and blood leukocyte DNA specimens. HIV-1 protease inhibitor resistance mutants may emerge in th e semen of patients receiving combination therapy.