title: Association of antiretroviral therapy with detection of HIV-1 RNA and DNA in the anorectal mucosa of homosexual men.
abstract: OBJECTIVE
  To determine whether combination antiretroviral therapy is associated with reduced detection of HIV-1 RNA and DNA in the anorectal mucosa of men who have sex with men (MSM).
  
  
  METHODS
  Cross-sectional study of 233 MSM recruited from community and clinic sites in Seattle, Washington between July 1996 and December 1997.
  
  
  METHODS
  HIV-1 RNA and HIV-1 DNA were detected in anorectal swab specimens by polymerase chain reaction amplification assays.
  
  
  RESULTS
  HIV-1 RNA was detected significantly less often in anorectal specimens from users of combination antiretroviral therapies, whether a protease inhibitor was received (15/89; 17%) or not (16/53; 30%), than in men not receiving therapy (43/88; 49%) (P < 0.001, P = 0.03, respectively). In contrast, HIV-1 DNA was detected only slightly less frequently in anorectal specimens obtained from men receiving protease inhibitors (35/81; 43%) or reverse transcriptase inhibitors alone (22/48; 46%) than in specimens from men not receiving therapy (45/78; 58%) (P = 0.07, P = 0.20, respectively). Among men with < 50 copies HIV-1 RNA/ml plasma, detection of HIV-1 RNA in anorectal specimens was rare (1/54; 2%) but detection of HIV-1 DNA was common (14/50; 28%).
  
  
  CONCLUSIONS
  Combination antiretroviral therapy is associated with reductions in HIV-1 RNA, but HIV-1 DNA remains detectable in the anorectal canal of almost half of MSM receiving such therapy. Condom use during anal intercourse should be encouraged, regardless of plasma viral load response to potent antiretroviral therapy.
authors.affiliation: Department of Epidemiology, Center for AIDS & STD, University of Washington, Seattle 98195, USA.
authors.forename: T M
authors.initials: TM
authors.lastname: Lampinen
authors.forename: C W
authors.initials: CW
authors.lastname: Critchlow
authors.forename: J M
authors.initials: JM
authors.lastname: Kuypers
authors.forename: C S
authors.initials: CS
authors.lastname: Hurt
authors.forename: P J
authors.initials: PJ
authors.lastname: Nelson
authors.forename: S E
authors.initials: SE
authors.lastname: Hawes
authors.forename: R W
authors.initials: RW
authors.lastname: Coombs
authors.forename: K K
authors.initials: KK
authors.lastname: Holmes
authors.forename: N B
authors.initials: NB
authors.lastname: Kiviat
mesh_terms: D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D004279:DNA, Viral / Q000032:analysis*; D004359:Drug Therapy, Combination; D015658:HIV Infections / Q000188:drug therapy / Q000821:virology*; D017320:HIV Protease Inhibitors / Q000627:therapeutic use; D015497:HIV-1 / Q000235:genetics / Q000302:isolation & purification*; D006716:Homosexuality; D006801:Humans; D007413:Intestinal Mucosa / Q000821:virology*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011533:Proviruses; D012367:RNA, Viral / Q000032:analysis*; D012007:Rectum / Q000821:virology*; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D004279:DNA, Viral; D017320:HIV Protease Inhibitors; D012367:RNA, Viral; D018894:Reverse Transcriptase Inhibitors