title: Post-prostatic massage fluid/urine as an alternative to semen for studying male genitourinary HIV-1 shedding.
abstract: OBJECTIVE
  Genitourinary tract samples are required to investigate male HIV-1 infectivity. Because semen collection is often impractical, the acceptability, feasibility and validity of post-prostatic massage fluid/urine (post-PMF/U) was evaluated for studying male genitourinary HIV-1 shedding.
  
  
  METHODS
  HIV-1-seropositive men were evaluated after 48 h of sexual abstinence. At each visit, a clinician performed prostatic massage, then post-PMF/U and blood were collected. Participants provided semen specimens 1 week later. An audio computer-assisted self-interview (ACASI) administered after each specimen collection evaluated acceptability, adherence to instructions and recent genitourinary symptoms. HIV-1 RNA was quantified using a real-time PCR assay. Detection and quantitation of HIV-1 RNA and stability over visits were compared for semen, post-PMF/U and blood.
  
  
  RESULTS
  Post-PMF/U was successfully obtained at 106 visits (64%) and semen at 136 visits (81%, p<0.001). In ACASI, discomfort was rated higher for post-PMF/U collection (p=0.003), but there was no significant difference in acceptability. Detection of HIV-1 RNA in post-PMF/U was associated with detection in semen (p=0.02). Semen and post-PMF/U HIV-1-RNA levels were correlated (ρ=0.657, p<0.001). Concordance of results at repeat visits was 78.9% for post-PMF/U (κ=0.519, p=0.02) and 89.5% for both blood and semen (κ=0.774, p=0.001).
  
  
  CONCLUSIONS
  Although semen collections were more successful, both post-PMF/U and semen collections were acceptable to many participants. HIV-1 RNA detection and levels were closely associated in semen and post-PMF/U, and results were relatively stable across visits. To assess male HIV-1 infectivity, post-PMF/U may represent a valid alternative when semen cannot be obtained.
authors.affiliation: University of Washington, Box 359909, 325 Ninth Avenue, Seattle, WA 98104-2499, USA. grahamsm@u.washington.edu
authors.forename: Susan M
authors.initials: SM
authors.lastname: Graham
authors.forename: John N
authors.initials: JN
authors.lastname: Krieger
authors.forename: Peter L M
authors.initials: PL
authors.lastname: Githua
authors.forename: Lorraine W
authors.initials: LW
authors.lastname: Wamuyu
authors.forename: Steven
authors.initials: S
authors.lastname: Wale
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Ramko
authors.forename: Joan A
authors.initials: JA
authors.lastname: Dragavon
authors.forename: Charles H
authors.initials: CH
authors.lastname: Muller
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Holte
authors.forename: Kishor N
authors.initials: KN
authors.lastname: Mandaliya
authors.forename: R Scott
authors.initials: RS
authors.lastname: McClelland
authors.forename: Norbert M
authors.initials: NM
authors.lastname: Peshu
authors.forename: Eduard J
authors.initials: EJ
authors.lastname: Sanders
authors.forename: Robert W
authors.initials: RW
authors.lastname: Coombs
mesh_terms: D000328:Adult; D012634:Bodily Secretions; D005240:Feasibility Studies; D015658:HIV Infections / Q000821:virology*; D015497:HIV-1; D006801:Humans; D008297:Male; D008405:Massage; D008875:Middle Aged; D011379:Prognosis; D011467:Prostate; D012367:RNA, Viral / Q000032:analysis; D012661:Semen / Q000821:virology*; D014566:Urogenital System / Q000821:virology*; D017201:Virus Shedding
chemical_list: D012367:RNA, Viral