EFFECTS OF REVERSE-TRANSCRIPTASE INHIBITOR THERAPY ON THE HIV-1 VIRALBURDEN IN SEMEN

HIV-1 infection continues to spread worldwide, primarily through sexua l intercourse. Because semen is a major vehicle for transmission of HI V-1, we evaluated the effects of reverse transcriptase inhibitor thera py on the amount of HIV-1 in semen. The semen and blood of 11 HIV-1-in fected men (i.e. treatment group) were collected before the initiation of reverse transcriptase inhibitor therapy and then 8 to 18 weeks aft er initiation of therapy. The semen and blood of another 11 HIV-1-infe cted men (i.e., longitudinal group), who were not on or had no change in antiretroviral therapy for at least 2 months before study entry, we re collected at approximately 2-week intervals for 10 to 26 weeks. In the treatment group, 82% of the seminal plasma HIV-1 RNA levels decrea sed from baseline after 8 to 18 weeks of therapy (median reduction of 1.01 log(10), p = 0.01), and 100% of the blood plasma RNA levels decre ased from baseline over the same period (median reduction of 0.92 log( 10), p = 0.003). Five of these patients were followed for at least 52 weeks and had a median seminal plasma HIV-1 RNA level of 0.66 log(10) below baseline at 1 year. All subjects in the treatment group with pos itive cultures at baseline (50%) had negative cultures or a lower infe ctious units per ejaculate at the 8- to 18-week follow-up examinations . The HIV-1 RNA levels in blood and semen of the longitudinal group di d not change significantly over 10 to 26 weeks. Initiation of reverse transcriptase inhibitor therapy effectively reduces shedding of HIV-1 in semen and may therefore reduce the spread of infection within popul ations.