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Rebound of Seminal HIV-1 Viral Load Associated with Sexually Transmitted Diseases (STDs) after Virologic Suppression by Antiretroviral Therapy P. F. BARROSO*1,3, M. SCHECHTER1, P. GUPTA2, F. C. MURTA1, M. VIEIRA1, M. F. MELO1, Y. SOUZA1, and L. H. HARRISON2.
1HUCFF, Federal Univ. of Rio de Janeiro, Brazil; 2Univ. of Pittsburgh, PA; and 3Johns Hopkins Univ., Baltimore, MD Background: STDs enhance HIV sexual transmission and genital HIV shedding. The impact of STDs on seminal HIV-1 shedding previously suppressed by antiretroviral therapy (ART) is unknown.
Methods: Cohort study of HIV-infected subjects during the first 6 months of antiretroviral therapy. HIV-1 RNA was measured in plasma (PVL) and whole semen (SVL) with the Nuclisens™ assay before introduction of ART and at 1, 2, 3 and 6 months thereafter (visits F1, F2, F3 and F6). STDs evaluation (clinical and laboratory) was performed at all study visits.
Results: A diagnosis of an STD in the thirty days period prior to the study visit was present in 6 (7%) of 89, 5 (6%) of 85, 5 (6%) of 88, and 4 (5%) of 88 patients returning for F1, F2, F3 and F6, respectively. Recurrent genital herpes simplex (9 episodes in 7 subjects) was the most frequent STDS. Three, 2, 1, 3, and 2 subjects had a newly diagnosed episode of syphilis, Chlamydia trachomatis infection, gonorrhea, Trichomonas vaginalis, and penile warts, respectively. None of the patients had a penile ulcer or urethral discharge at the time semen was provided. In 16 of these 20 events seminal viral load was below the limit of detection (400 copies/ml). Two of 4 patients with detectable seminal viral load at the follow-up visit in which an STDS was diagnosed had undetectable seminal viral loads both at the previous and the subsequent visit. These data suggest that STDs may be associated with a temporary rebound in seminal HIV-1 shedding in patients using antiretroviral therapy.
Conclusions: The beneficial impact of antiretroviral therapy in reducing seminal HIV-1 shedding may be attenuated by the occurrence of STDs.
Key Words: semen, STDs, viral load
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