The effects of antiretroviral therapy on HIV-1 RNA loads in seminal plasma in HIV-positive patients with and without urethritis.
BACKGROUND
High seminal plasma HIV-1 RNA loads (SVL) have been reported during gonococcal, non-gonococcal and chlamydial urethritis in patients not taking antiretroviral therapy.


OBJECTIVE
To examine if urethritis leads to increased SVL in HIV-positive patients taking antiretroviral therapy.


METHODS
Men who had been taking therapy for at least 3 months were recruited: 24 had urethitis (PWU) and 16 were without urethritis (controls). At three visits, 1 week apart, blood plasma viral load (BVL) and SVL were assayed by quantitative polymerase chain reaction or the NASBA assay.


RESULTS
Most subjects had undetectable SVL (18 PWU, 13 controls). Among those with undetectable BVL prior to first study visit, virus was undetectable in semen in 5/5 episodes of chlamydial urethritis, 6/7 episodes of non-gonococcal urethritis and 4/5 cases of gonococcal urethritis. Two PWU with undetectable BVL just prior to the first study visit had low to moderate SVL, which became undetectable by visit 2 following treatment. Of nine subjects with detectable SVL, eight had detectable BVL (3/3 controls and 5/6 PWU). Of these, 1/3 controls and 4/5 PWU (all with gonococcal urethritis) had poorly controlled BVL just prior to the first study visit. These four PWU had high SVL and one had higher levels in semen than in blood. This patient's SVL was reduced more than 20-fold following treatment for gonococcal urethritis.


CONCLUSIONS
Effective antiretroviral therapy appeared to limit the effect of urethritis on SVL. When BVL was poorly controlled by antiretroviral therapy, high SVL occurred during gonococcal urethritis, increasing the potential risk of transmitting both wild type and drug resistant strains of HIV-1.
Sadiq
S Tariq
ST
Camden & Islington Community NHS Trust and Department of Sexually Transmitted Diseaeases and Virology, Royal Free and University College Medical School, University College, London, UK.
Taylor
Stephen
S
Kaye
Steve
S
Bennett
Julie
J
Johnstone
Ruth
R
Byrne
Patrick
P
Copas
Andrew J
AJ
Drake
Susan M
SM
Pillay
Deenan
D
Weller
Ian
I
D000328:Adult; D018791:CD4 Lymphocyte Count; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000276:immunology / Q000821:virology*; D015497:HIV-1 / Q000235:genetics; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D012367:RNA, Viral / Q000032:analysis; D012661:Semen / Q000821:virology*; D014526:Urethritis / Q000150:complications / Q000276:immunology / Q000821:virology*; D019562:Viral Load
D012367:RNA, Viral