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Detection of HIV-1 RNA in Seminal Plasma Samples from Treated Patients with Undetectable HIV-1 RNA in Blood Plasma
Anne-Genevieve Marcelin*1, R Tubiana1, S Lambert-Niclot1, G Lefebvre2, S Dominguez1, M Bonmarchand1, D Vauthier-Brouzes1, F Marguet1, G Peytavin1, C Poirot1, and the Pitie-Salpetriere AMP a Risque Viral Study Group
1Hosp Pitie-Salpetriere, Paris, France and 2Hopital Bichat-Claude Bernard, Paris, France
Background: Recently, the Swiss Federal
Commission for HIV/AIDS stated that a seropositive individual, with no other
sexually transmitted disease (STD), under ART, and with an undetectable HIV-1
plasma viral load for at least 6 months, does not sexually transmit HIV. However,
HIV blood viral load might not always reflect HIV replication levels in semen. The
aim of this study was to evaluate the residual HIV RNA shedding in semen from
patients who have undergone prolonged successful HAART treatment.
Methods: Between January 2002 and January
2008, 145 HIV-1-infected men attending the Pitié-Salpêtrière Hospital in the multidisciplinary assisted reproductive technology program provided 264 paired
blood and semen samples. The Cobas Taqman HIV-1 Assay was used to quantify
HIV-1 RNA in blood and in seminal plasma as previously described with a limit
of quantification of 40 copies/mL in blood and 200 copies/mL in seminal plasma.
Pharmacological measurements were performed in blood and seminal plasma.
Results: Overall, 234 paired samples were
concordant, with 225 samples with undetectable HIV-1 RNA both in blood and
semen (85.3 %) and 9 with detectable HIV-1 RNA in blood and semen (3.4%).
However, 23 blood samples had detectable HIV-1 RNA although the seminal viral
load was undetectable and 7 seminal samples had detectable HIV-1 RNA although
the blood viral load was undetectable. These 7 discordant paired samples
corresponded to 7 distinct patients. All these patients were under stable HAART
with an undetectable HIV-1 RNA in blood plasma for at least 6 months and had no
other STD that are systematically screened in the program. When antiretroviral
drugs such as lamivudine, tenofovir, and indinavir were present in blood they
were also detected in semen.
Conclusions: These results show that 5% of
patients had detectable HIV-1 RNA in semen although they had concomitantly
undetectable HIV-1 RNA in blood while they were under HAART. These results
should be taken into account in public health messages. Indeed, while effective
antiretroviral therapy is likely to substantially reduce HIV transmission at a
population level, residual HIV RNA shedding can occur.
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