title: Risk factors for HIV-1 shedding in semen.
abstract: Semen is the body fluid most commonly associated with sexual transmission of human immunodeficiency virus type-1 (HIV-1). Because the male genitourinary tract is distinct immunologically from blood, compartment-dependent factors may determine HIV-1 shedding in semen. To identify these factors, the authors obtained 411 semen and blood specimens from 149 men seen up to three times. Seminal plasma was assayed for HIV-1 RNA and semen was cocultured for HIV-1 and cytomegalovirus (CMV), which may up-regulate HIV-1 replication. The best multivariate model for predicting a positive semen HIV-1 coculture included two local urogenital factors, increased seminal polymorphonuclear cell count (odds ratio (OR) = 12.6 for each log10 increase/mL, 95% confidence interval (CI) 12.2, 134.5) and a positive CMV coculture (OR = 3.0, 95% CI 1.2, 7.7). The best multivariate model for predicting semen HIV-1 RNA included two systemic host factors, CD4+ cell counts <200/microliter (OR = 3.0, 95 percent CI 1.3, 6.9) and nucleoside antiretroviral therapy (monotherapy: OR = 0.5, 95% CI 0.3, 1.0; combination therapy: OR = 0.4, 95% CI 0.2, 0.9), and a positive CMV coculture (OR = 1.7, 95% CI 1.0, 3.0). Thus, both systemic and local genitourinary tract factors influence the risk of semen HIV-1 shedding. These findings suggest that measures of systemic virus burden alone may not predict semen infectivity reliably.
authors.affiliation: Department of Epidemiology, University of Washington, Seattle 98195, USA.
authors.forename: C E
authors.initials: CE
authors.lastname: Speck
authors.forename: R W
authors.initials: RW
authors.lastname: Coombs
authors.forename: L A
authors.initials: LA
authors.lastname: Koutsky
authors.forename: J
authors.initials: J
authors.lastname: Zeh
authors.forename: S O
authors.initials: SO
authors.lastname: Ross
authors.forename: T M
authors.initials: TM
authors.lastname: Hooton
authors.forename: A C
authors.initials: AC
authors.lastname: Collier
authors.forename: L
authors.initials: L
authors.lastname: Corey
authors.forename: A
authors.initials: A
authors.lastname: Cent
authors.forename: J
authors.initials: J
authors.lastname: Dragavon
authors.forename: W
authors.initials: W
authors.lastname: Lee
authors.forename: E J
authors.initials: EJ
authors.lastname: Johnson
authors.forename: R R
authors.initials: RR
authors.lastname: Sampoleo
authors.forename: J N
authors.initials: JN
authors.lastname: Krieger
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D018920:Coculture Techniques; D003587:Cytomegalovirus / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000821:virology; D015658:HIV Infections / Q000821:virology*; D015497:HIV-1 / Q000302:isolation & purification* / Q000502:physiology; D018451:Homosexuality, Male; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012367:RNA, Viral / Q000032:analysis; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012307:Risk Factors; D012661:Semen / Q000821:virology*; D017201:Virus Shedding
chemical_list: D012367:RNA, Viral