• Brendan J W Osborne, Prameet M Sheth, Tae Joon Yi, Colin Kovacs, Erika Benko, Charles la Porte, Sanja Huibner, Anh Q Le, Ryan Danroth, Bemuluyigza Baraki, Tony Mazzulli, Zabrina L Brumme, and Rupert Kaul.
• Department of Medicine, University of Toronto, Ontario, Canada. ebrendan.osborne@utoronto.ca
• J. Infect. Dis. 2013 Apr 15;207(8):1226-34.

BackgroundEffective antiretroviral therapy (ART) dramatically reduces human immunodeficiency virus (HIV) transmission. However, isolated shedding of HIV type 1 (HIV-1) in semen (IHS) can occur in the absence of detectable viremia or genital infections. We hypothesized that ART intensification with medications active in semen might prevent IHS.MethodsPaired blood and semen samples were collected monthly for 6 months from HIV-infected men starting ART that was intensified (iART) with maraviroc and raltegravir in an open-label fashion. Semen parameters were compared to those of historical controls starting standard ART (sART).ResultsCompared with 25 controls who started sART, the semen HIV-1 load in 13 subjects who started iART was more rapidly suppressed (P = .043). IHS was detected at >1 visit in 2 participants (15%) receiving iART and in 12 controls (48%) receiving sART (P = .040). Among iART recipients, IHS was associated with lower raltegravir concentrations in blood and semen, compared with complete HIV-1 suppression (P = .03). Prolonged, high-level IHS (ie, shedding of >5000 RNA copies/mL) was observed in 1 iART recipient (8%), despite rapid viremia suppression and therapeutic drug levels; for 10 months, this virus remained R5 tropic, drug susceptible, and similar in sequence to virus recovered from blood. IHS was not seen after >3 years of effective ART in a parallel, prospective cohort study.ConclusionsiART transiently reduced the occurrence of IHS early after ART initiation but did not prevent high-level IHS. IHS was not seen after more prolonged sART.

46 keywords...

hide…