EFFECT OF ANTIVIRAL TREATMENT ON THE SHEDDING OF HIV-1 IN SEMEN

Objective: The potential role of antiretroviral treatment on the infec tiousness of HIV-1-infected men was examined by studying the effect of antiviral treatment on the shedding of HIV-1 in semen. Methods: Forty -four patients enrolled in various treatment protocols were asked to d onate a semen sample before they began a new antiviral treatment and a l a follow-up visit after 6 to 15 weeks of treatment. Since most patie nts were on blinded protocols, patients were stratified by response of blood viral load. The effect of each patient's treatment was classifi ed as good (n = 24), fair (n = 8) and marginal (n = 13) by measurement of the HIV RNA reduction in blood plasma (> 1.0 log(10); 0.5-1.0 log( 10), and <0.5 log(10) HIV RNA copies/ml reduction, respectively). The effect of treatment on shedding of HIV-1 in semen was documented by th e reduction of HIV RNA concentration in seminal plasma and by quantita tive HIV-1 seminal cell culture. Results: Overall, antiviral treatment resulted in a significant fall in the viral load in semen (RNA and cu lture) that paralleled the reduction of viral load in blood. More pron ounced reductions of HIV RNA in semen were observed as the effectivene ss of treatment on blood HIV RNA levels increased (median drop from ba seline 0, 0.3 log(10) and 0.8 log(10) RNA copies/ml in patients with m arginal, fair and good treatment effect, respectively). Thirteen patie nts lost detectable HIV RNA in blood on treatment and all of these had undetectable levels of HIV-1 in semen by culture and RNA analysis at follow-up. In 19 of the 31 patients (62%) who still had HIV RNA in the ir blood during treatment, semen HIV levels were below detection in se men at follow-up. Conclusions: Treatment-induced changes of HIV RNA co ncentration in blood are generally associated with a corresponding cha nge in seminal HIV RNA: If confirmed in larger studies, potent antiret roviral therapy might reduce the spread of HIV-1.