Correlation between HIV-1 RNA load in blood and seminal plasma depending on antiretroviral treatment status, regimen and penetration of semen by antiretroviral drugs
To assess the correlation between HIV-1 RNA load in blood and semen byantiretroviral therapy status and the relative penetration of antiretroviraldrugs in seminal plasma. We performed a cross-sectional cohort study of 119 HIV-1subjects divided into three groups according to treatment status. Blood and semenwere collected concurrently. Seminal viral load determined by NucliSens HIV-1 QT PCR (BioMerieux). Viral suppression over time was assessed in a second semensample collected from 10 treated subjects. Antiretroviral plasma concentrationswere measured by high performance liquid chromatography and recovery experiments were performed on semen samples to validate quantitation in this matrix. Allsubjects taking non nucleoside reverse transcriptase inhibitors (n = 36, meantreatment 33 months +/- 14) or protease inhibitors (n = 45, mean treatment 31months +/- 25) had blood viral load < 50 copies/mL and seminal viral load < 250copies/mL. In untreated subjects (n = 38), blood and semen viral loads werepositively correlated (Spearman's rho = 0.489, p = 0.002). Blood and semennevirapine concentrations were positively correlated (r(2) = 0.795, p = 0.005)and therapeutic concentrations achieved in both compartments. Lopinavir andatazanavir also penetrated semen but efavirenz did not. We find that there iscompartmentalisation of HIV-1 within the male genital tract and propose that new infections may originate from untreated men and that suppressive antiretroviralregimens may reduce the risk of sexual transmission.
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