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Increased Seminal Shedding of HIV during Primary Infection Augments the Need for Earlier Diagnosis and Prevention P. VERNAZZA*1, L. PERRIN2, S. VORA2, D. COOPER3, M. BLOCH3, R. FINLAYSON3, D. BAKER3, B. GAZZARD4, S. KINLOCH4, M. TYRER4, H. GAINES5, S. STASZEWSKI6, N. CLUMECK8, G. TAMBUSSI8, and L. GOH8.
1St. Gallen; 2Geneva; 3Australia; 4UK; 5Sweden; 6Germany; 7Belgium; and 8Glaxo Wellcome Objective: To estimate HIV infectiousness during primary HIV infection (PHI) and to evaluate the effect of treatment on genital shedding of HIV.
Method: From the QUEST study, baseline (bl) semen and follow-up samples obtained within the first month or after one year of HAART (CBV/ABV/APV) were available from 31, 19 and 14 PHI patients, respectively. HIV was quantified by a modified ultrasensitive RNA-PCR technique. HIV shedding was compared between PHI and a historical control of 39 drug naive chronically infected, asymptomatic men (CAI). bl HIV RNA semen:plasma pairs from matching intrasubject PHI samples were also compared.
Results: Detection rates for HIV-RNA (LLD < 50 c/mL ejaculate) in semen from the study cohort were 30/31(97%), 19/19 (100%) and 1/14 (7%) at bl, after one month and a year of HAART respectively. Median HIV-RNA/mL ejaculate was significantly higher (p<0.01) in PHI (4.5 log c/mL) than in CAI (3.23 log/mL). Two wks HAART in PHI subjects conferred a 1.6 log drop in seminal plasma HIV-RNA levels below those seen in CAI. Qualitative HIV-DNA PCR in seminal cells were significantly higher in PHI than in CAI (92% vs. 33%, p<0.001) and this difference is expected to be wider with ongoing DNA–PCR quantitation. bl HIV RNA levels in semen were 0.85 log10 below corresponding plasma levels.
Conclusion: The cell-free and cellular viral burden in semen is significantly higher during PHI than during CAI and treatment successfully suppresses genital shedding of HIV. This finding strengthens the importance of early diagnosis and treatment of HIV infection.
Key Words: infectivity, primary infection, semen
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