Highly active antiretroviral therapy does not completely suppress HIV in semen of sexually active HIV-infected men who have sex with men.
Highly active antiretroviral therapy does not completely suppress HIV in semen of sexually active HIV-infected men who have sex with men.
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DOI：
10.1097/qad.0b013e328353b11b
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发表时间：
2012-07-31
期刊：
影响因子：
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通讯作者：
Anderson DJ
中科院分区：
文献类型：
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作者：
Politch JA;Mayer KH;Welles SL;O'Brien WX;Xu C;Bowman FP;Anderson DJ
目的：尽管HAART可以抑制HIV的生殖器脱落和性传播，但在HAART时代，男男性行为者（MSM）经历了HIV流行的死灰复燃。尽管有高效抗逆转录病毒疗法，但许多感染艾滋病毒的男男性行为者仍继续进行不安全的性行为，性传播感染（STI）或其他因素可能促进生殖器艾滋病毒脱落和传播。在这项研究中，我们确定了艾滋病病毒感染的男男性接触者在稳定的HAART，其与一些临床，行为和生物学variables.Design：性活跃的艾滋病病毒感染的男性使用HAART的患病率精液HIV脱落招募从男男性接触者健康诊所提供精液和血液samples.Methods：HIV水平进行了评估配对的精液和血液样本通过PCR。临床和行为数据来自医疗记录和问卷调查。单纯疱疹病毒2型（HSV-2）血清状态，精液HSV-2 DNA，生殖器炎症的标志物进行了测量，使用标准的实验室方法。结果：总体而言，HIV-1检测18 101（18%）的血液和30 101（30%）精液样本。在83名血浆中检测不到艾滋病毒的男性中，25%的男性精液中有艾滋病毒，拷贝数从80到2560不等。多因素分析显示STI/尿道炎（P= 0.003）、肿瘤坏死因子α（P= 0.0003）和与HIV感染者无保护插入肛交（P= 0.007）是精液HIV检出的独立预测因子。结论：性传播疾病和生殖器炎症可部分抵消HAART对性活跃HIV感染MSM精液HIV排出的抑制作用。精液中HIV滴度低可能会在MSM中造成传播风险，因为MSM对HIV感染高度敏感。
Objective:Although HAART can suppress genital shedding and sexual transmission of HIV, men who have sex with men (MSM) have experienced a resurgent HIV epidemic in the HAART era. Many HIV-infected MSM continue to engage in unsafe sex, and sexually transmitted infections (STIs) or other factors may promote genital HIV shedding and transmission in this population despite HAART. In this study, we determined the prevalence of seminal HIV shedding in HIV-infected MSM on stable HAART, and its relationship with a number of clinical, behavioral and biological variables.Design:Sexually active HIV-infected men using HAART were recruited from an MSM health clinic to provide semen and blood samples.Methods:HIV levels were assessed in paired semen and blood samples by PCR. Clinical and behavioral data were obtained from medical records and questionnaires. Herpes simplex virus 2 (HSV-2) serostatus, seminal HSV-2 DNA, and markers of genital inflammation were measured using standard laboratory methods.Results:Overall, HIV-1 was detected in 18 of 101 (18%) blood and 30 of 101 (30%) semen samples. Of 83 men with undetectable HIV in blood plasma, 25% had HIV in semen with copy numbers ranging from 80 to 2560. Multivariate analysis identified STI/urethritis (P= 0.003), tumor necrosis factor α (P= 0.0003), and unprotected insertive anal sex with an HIV-infected partner (P= 0.007) as independent predictors of seminal HIV detection.Conclusion:STIs and genital inflammation can partially override the suppressive effect of HAART on seminal HIV shedding in sexually active HIV-infected MSM. Low seminal HIV titers could potentially pose a transmission risk in MSM, who are highly susceptible to HIV infection.