title: Persistence of human immunodeficiency virus in semen after adding indinavir to combination antiretroviral therapy.
abstract: Changes in human immunodeficiency virus (HIV) type 1 concentration and protease genotype were evaluated in semen specimens from 22 HIV-positive men before and 6 months after the addition of indinavir to dual nucleoside therapy. Seminal HIV was detected by polymerase chain reaction analysis for DNA or RNA for 59% of men before combination treatment and persisted at 6 months for 31% of the men who initially had seminal HIV detected (P = .026). The maximum levels of cell-free RNA, cell-associated RNA, and proviral DNA in semen before treatment and at 6 months were 400,000 and 10,000 copies/mL, 70,000 and 27,000 copies/mL, and 80,000 and 3,000 copies/mL, respectively. Three of the four men with persistent seminal DNA had plasma viral loads of > 10,000 copies/mL before treatment. One patient who became intolerant to indinavir had seminal HIV RNA detected by PCR analysis after 6 months. Although none of the cultures of semen specimens from the four men with PCR analysis-detectable seminal DNA after 6 months yielded HIV, indinavir resistance mutations were identified in a seminal leukocyte DNA specimen from one patient, and a second patient whose therapy was switched to saquinavir had different protease inhibitor resistance mutations in seminal and blood leukocyte DNA specimens. HIV-1 protease inhibitor resistance mutants may emerge in the semen of patients receiving combination therapy.
authors.affiliation: Fenway Community Health Center, Brigham and Women's Hospital, Massachusetts General Hospital, and Harvard Medical School, Boston, USA. Kenneth_Mayer@brown.edu
authors.forename: K H
authors.initials: KH
authors.lastname: Mayer
authors.forename: S
authors.initials: S
authors.lastname: Boswell
authors.forename: R
authors.initials: R
authors.lastname: Goldstein
authors.forename: W
authors.initials: W
authors.lastname: Lo
authors.forename: C
authors.initials: C
authors.lastname: Xu
authors.forename: L
authors.initials: L
authors.lastname: Tucker
authors.forename: M P
authors.initials: MP
authors.lastname: DePasquale
authors.forename: R
authors.initials: R
authors.lastname: D'Aquila
authors.forename: D J
authors.initials: DJ
authors.lastname: Anderson
mesh_terms: D019380:Anti-HIV Agents / Q000008:administration & dosage*; D018791:CD4 Lymphocyte Count; D004279:DNA, Viral / Q000032:analysis; D004359:Drug Therapy, Combination; D016333:HIV Protease / Q000235:genetics; D017320:HIV Protease Inhibitors / Q000008:administration & dosage*; D015497:HIV-1 / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D019469:Indinavir / Q000008:administration & dosage*; D008137:Longitudinal Studies; D008297:Male; D012367:RNA, Viral / Q000032:analysis; D012661:Semen / Q000821:virology*
chemical_list: D019380:Anti-HIV Agents; D004279:DNA, Viral; D017320:HIV Protease Inhibitors; D012367:RNA, Viral; D019469:Indinavir; D016333:HIV Protease