Reduction of concentration of HIV-1, in semen after treatment of urethritis: Implications for prevention of sexual transmission of HIV-1
Reduction of concentration of HIV-1, in semen after treatment of urethritis: Implications for prevention of sexual transmission of HIV-1
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DOI：
10.1016/s0140-6736(97)02190-9
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发表时间：
1997-06-28
期刊：
影响因子：
168.9
通讯作者：
Gilliam, B
中科院分区：
文献类型：
--
作者：
Cohen, MS;Hoffman, IF;Gilliam, B
背景在撒哈拉以南非洲，艾滋病毒-1的传播主要是通过异性接触，那里的性传播疾病(STDS)也很常见。流行病学研究表明，性病促进了HIV-1的传播，但其生物学机制尚不清楚，我们调查了STD通过增加精液中病毒浓度来增加HIV-1传播可能性的假设。方法检测马拉维135名HIV-1血清阳性男性、86名尿道炎患者和49名对照组的精液和血浆中HIV-1 RNA浓度。根据马拉维性病咨询委员会的指导方针，患有尿道炎的男性接受了抗生素治疗。尿道炎患者在抗生素治疗后第1周和第2周，以及对照组在基线和第2周进行样本分析。发现HIV-1阳性尿道炎患者精浆中HIV-1RNA浓度是非尿道炎患者精浆中HIV-1RNA浓度的8倍(12.4vs1.51x10(4)拷贝/毫升，p=0.035)，尽管CD_4计数和血浆病毒RNA浓度相似。淋病与精液中HIV-1浓度最高(15.8×10(4)拷贝/毫升)有关。尿道炎患者经针对性病的抗菌治疗后，精液中HIV-1RNA浓度显著下降(从12.4×10(4)拷贝/毫升下降到8.91×10(4)拷贝/毫升[p=0.03]和4.12×10(4)拷贝/毫升(p=0.0001))。血浆病毒RNA浓度无明显变化。对照组的精浆中HIV-1RNA浓度在两周内没有显著变化(p=0.421)。这些结果表明尿道炎增加了感染HIV-1的男性的传染性。艾滋病毒-1控制方案，包括检测和治疗已经感染艾滋病毒-1的患者的性传播疾病，可能有助于遏制这一流行病。针对淋球菌性尿道炎可能是一种特别有效的策略。
Background transmission of HIV-1 is predominantly by heterosexual contact in sub-Saharan Africa, where sexually transmitted diseases (STDs) are also common. Epidemiological studies suggest that STDs facilitate transmission of HIV-1, but the biological mechanism remains unclear, We investigated the hypothesis that STDs increase the likelihood of transmission of HIV-1 through increased concentration of the virus in semen.Methods HIV-1 RNA concentrations were measured in seminal and blood plasma from 135 HIV-1-seropositive men in Malawi; 86 had urethritis and 49 controls did not have urethritis. Men with urethritis received antibiotic treatment according to the guidelines of the Malawian STD Advisory Committee. Samples were analysed at baseline and at week 1 and week 2 after antibiotic therapy in urethritis patients, and at baseline and week 2 in the control group.Findings HIV-1-seropositive men with urethritis had HIV-1 RNA concentrations in seminal plasma eight times higher than those in seropositive men without urethritis (12.4 vs 1.51x10(4) copies/mL, p=0.035), despite similar CD4 counts and concentrations of blood plasma viral RNA. Gonorrhoea was associated with the greatest concentration of HIV-1 in semen (15.8x10(4) copies/mL). After the urethritis patients received antimicrobial therapy directed against STDs, the concentration of HIV-1 RNA in semen decreased significantly (from 12.4x10(4) copies/mL to 8.91x10(4) copies/mL at 1 week [p=0.03] and 4.12x10(4) copies/mL at 2 weeks [p=0.0001]). Blood plasma viral RNA concentrations did not change. There was no significant change in seminal plasma HIV-1 RNA concentrations during the 2-week period in the control group (p=0.421).These results suggest that urethritis increases the infectiousness of men with HIV-1 infection. HIV-1-control programmes, which include detection and treatment of STDs in patients already infected with HIV-1, may help to curb the epidemic. Targeting of gonococcal urethritis may be a particularly effective strategy.