Adherence to antiretroviral therapy and persistence of HIV RNA in semen.
BACKGROUND
Long-term adherence to antiretrovirals is critical for sustained virologic response to HIV therapy in blood. Although antiretroviral therapy (ART) reduces HIV seminal shedding, little is known about the relationship between adherence to ART and HIV suppression in semen.


OBJECTIVE
To determine predictors of seminal HIV RNA suppression after 6 months of ART.


METHODS
Prospective observational cohort of 93 HIV-infected subjects before and after introduction of ART. Seminal HIV RNA was measured at baseline and 1, 2, 3, and 6 months after the introduction of therapy. Adherence to therapy was measured by self-report.


METHODS
A large academic HIV reference center in Rio de Janeiro, Brazil.


METHODS
Detectable HIV RNA in semen.


RESULTS
In a multivariate logistic model with undetectable seminal HIV RNA after 6 months of therapy as the outcome variable, adjusting for baseline seminal viral load, both being adherent to therapy (OR = 11.8, < 0.01) and using triple-drug ART (OR = 6.48, = 0.04) were independently associated with seminal HIV RNA suppression.


CONCLUSIONS
Inability to adhere to therapy was strongly associated with persistent shedding of HIV RNA in semen. Measures to improve adherence are urgently needed to reduce the sexual spread of potentially drug-resistant HIV among subjects using antiretrovirals.
Barroso
Paulo F
PF
Infectious Diseases Sevice, Department of Preventive Medicine, Hospital Universitário Clementino Fraga Filho, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil. paulobarr@hucff.ufrj.br
Schechter
Mauro
M
Gupta
Phalguni
P
Bressan
Clarisse
C
Bomfim
Antonieta
A
Harrison
Lee H
LH
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D006678:HIV / Q000302:isolation & purification*; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology / Q000821:virology; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D010349:Patient Compliance; D012367:RNA, Viral / Q000302:isolation & purification*; D012661:Semen / Q000821:virology*; D013997:Time Factors
D000998:Antiviral Agents; D012367:RNA, Viral