Discordance in HIV-1 viral loads and antiretroviral drug concentrations comparing semen and blood plasma
Discordance in HIV-1 viral loads and antiretroviral drug concentrations comparing semen and blood plasma
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DOI：
10.1111/j.1468-1293.2009.00725.x
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发表时间：
2009-10-01
期刊：
影响因子：
3
通讯作者：
MacPherson, P.
中科院分区：
文献类型：
--
作者：
Lorello, G.;la Porte, C.;MacPherson, P.
目的：对于未接受抗逆转录病毒治疗的个体，当血浆（BP）病毒载量< 1500 HIV-1 RNA拷贝/mL时，异性传播HIV的风险似乎可以忽略不计。目前尚不清楚这一观察结果是否可以外推到接受高效抗逆转录病毒治疗（HAART）的个体。由于不同的组织渗透，抗逆转录病毒药物浓度可能足以维持BP中不可检测的病毒载量，但无法达到足够的水平来抑制生殖道中的HIV。因此，我们想关联HIV病毒载量和药物浓度在精液血浆（SP）和BP。Methods 33名男子。所有患者均接受抗逆转录病毒联合治疗，BP病毒载量检测不到至少1年。血液和精液样本收集在2小时内的每一个和测试HIV RNA的NucliSens QT（生物梅里埃，圣罗兰，QC，加拿大）的方法;药物浓度测定液相色谱串联mass spectrometry.ResultsTwo的33例（6.1%）BP病毒载量低于检测时间匹配的HIV病毒载量在SP >= 700拷贝/mL。这两个病人都依法韦仑，SP的浓度< 10%的BP水平，远低于最低治疗药物监测目标浓度所需的抑制HIV.ConclusionsBecause，至少部分，药物渗透到生殖道，一个不可检测的HIV病毒载量在BP不能保证一个不可检测的病毒载量在精液中。有鉴于此，应谨慎得出结论，即HAART治疗的病毒血症受抑制的患者在性方面无感染性。
ObjectivesFor individuals not on antiretroviral therapy, the risk of heterosexual transmission of HIV appears negligible when blood plasma (BP) viral loads are < 1500 HIV-1 RNA copies/mL. It is not clear whether this observation can be extrapolated to individuals on highly active antiretroviral therapy (HAART). Because of differential tissue penetration, antiretroviral drug concentrations may be sufficient to maintain an undetectable viral load in the BP yet not achieve adequate levels to suppress HIV in the genital tract. Therefore, we wanted to correlate HIV viral loads and drug concentrations in semen plasma (SP) and BP.MethodsThirty-three men were included. All were on combination antiretroviral therapy with an undetectable BP viral load for at least 1 year. Blood and semen samples were collected within 2 h of each other and tested for HIV RNA by the NucliSens QT (bioMerieux, St Laurent, QC, Canada) method; drug concentrations were determined by liquid chromatography tandem mass spectrometry.ResultsTwo of the 33 patients (6.1%) with BP viral loads below detection had time-matched HIV viral loads in SP >= 700 copies/mL. Both patients were on efavirenz, the SP concentrations of which were < 10% of the levels in BP and well below the minimal therapeutic drug monitoring target concentration required to suppress HIV.ConclusionsBecause, at least in part, of poor drug penetration into the genital tract, an undetectable HIV viral load in the BP does not guarantee an undetectable viral load in semen. In view of this, caution should be taken in concluding that patients on HAART with suppressed viraemia are sexually non-infectious.