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Predictors of Seminal Viral Load (SVL) Suppression in Subjects Starting Antiretroviral Therapy (ART) P. F. BARROSO1,3, L. H. HARRISON2, P. GUPTA2, F. C. MURTA1, Y. SOUZA1, M. F. MELO1, M. VIEIRA1, and M. SCHECHTER1.
1HUCFF, Federal Univ. of Rio de Janeiro, Brazil; 2Univ. of Pittsburgh, PA; and 3Johns Hopkins Univ., Baltimore, MD Background: Long-term adherence to ART is critical to sustain a virologic suppression in blood. Although ART reduces SVL, little is known about the relation of adherence to ART and virologic response in semen.
Objective: To determine predictors of SVL suppression (SVL < 400 cps/ml) after 6 months of ART.
Methods: A cohort study of 93 subjects starting ART in Rio de Janeiro, Brazil. HIV-1 viral load was measured with NuclisensŪ (lower limit of detection = 400 cps/ml) in blood plasma (PVL) and whole semen before subjects started ART and at 1, 2, 3 and 6 months after introduction of ART. Adherence was measured by self-report and was defined as "taking ART as prescribed more than 80% of days in the previous 30 days". Antiretrovirals were prescribed according to the Brazilian standard of care for HIV-1 infected subjects.
Results: The percentage of individuals with detectable SVL and PVL was reduced from 74% to 25% and 96% to 44%, respectively, in 85 subjects who completed 6 months of ART. The 64 patients with detectable SVL at baseline were included in the prediction analysis. At the 6-months follow-up visit (FUP), 18 of 48 (38%) individuals using a non-PI double nucleoside regimen and 2 of 16 (13%) using a PI containing regimen had detectable SVL (p=0.06). 76 % of the 53 "adherent" patients had detectable SVL as opposed to 30% of the 10 "non-adherent" (p<0.01). In a logistic model with undetectable SVL at FUP as the outcome variable, adjusting for baseline SVL, both being adherent (odds ratio= 11.8, p<0.01) and using a PI containing regimen (odds ratio=6.5, p=0.04) were independently associated with SVL suppression.
Conclusions: This study demonstrates that use of potent ART is associated with a lack of SVL suppression in persons who are unable to adhere. Measures to improve adherence are urgently needed to reduce the spread of ART-resistant HIV.
Key Words: adherence, antiretrovirals, semen
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