Poor reduction of HIV-1 RNA titres in nucleoside reverse transcriptase inhibitor experienced patients treated with indinavir combination therapy

Objectives: The long term effectiveness of combination therapy at reducing viral loads in seminal fluid and blood plasma obtained from HIV-1 infected men who had undergone previous antiretroviral therapy was assessed. Methods: Samples of semen and blood were obtained from a cohort of 12 nucle oside reverse transcriptase inhibitor experienced men before and during 25- 68 weeks of combination therapy, which included the protease inhibitor indi navir. HIV-1 RNA titres present in the cell free blood and seminal plasma s amples were determined using the nucleic acid sequence based amplification (NASBA)/Nuclisens assay system. Results: Viral RNA was detected in 9/12 and 7/12 baseline blood plasma and seminal plasma samples, with median viral titres of 10(4.81) and 10(4.56) p er ml, respectively. By the end of the study period the detection rates of HN RNA in the blood and seminal plasma samples were 5/12 and 2/12, respecti vely, with the median viral titres below the assay cut off level for both s ample types. Of the nine patients who had detectable viral RNA in the basel ine sample, only three cleared virus from both compartments by the end of t he study. Conclusions: These data show that stable reduction of blood and seminal flu id viral titres is not achievable in a significant proportion of nucleoside reverse transcriptase inhibitor experienced men.