title: HIV-1 RNA rectal shedding is reduced in men with low plasma HIV-1 RNA viral loads and is not enhanced by sexually transmitted bacterial infections of the rectum.
abstract: BACKGROUND
  Among human immunodeficiency virus (HIV)-infected men who have sex with men (MSM) taking combination antiretroviral therapy (cART), the impact of rectal sexually transmitted infections (STIs) on rectal HIV-1 shedding is unknown.
  
  
  METHODS
  Human immunodeficiency virus type 1 (HIV-1) RNA was quantified from rectal swabs collected for Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) screening of HIV-1-infected MSM. Correlations of STIs with rectal viral load were explored using multinomial regression modeling. HIV-1 coreceptor tropism was predicted from sequencing in a subset of men.
  
  
  RESULTS
  Thirty-one (39%) of 80 men (59 prescribed combination antiretroviral therapy [cART]) had HIV detected in 38 (42%) of 91 rectal swabs. Rectal HIV detection was associated with plasma virus loads above 3.15 log₁₀ copies/mL (95% confidence limit [CL] 2.73, 3.55) and paired rectal viral loads and plasma viral loads were correlated (Kendall's tau [τ] 0.68, Spearman rho [P] = .77). Rectal STIs and abnormal anal cytology were not associated with rectal viral load. HIV coreceptor distribution was very similar between the plasma and rectum in 3 of 4 men.
  
  
  CONCLUSIONS
  Plasma and rectal viral load were correlated, and rectal STIs did not increase the likelihood of detecting HIV in the rectal secretions in MSM, including those with low or undetectable plasma viral load. Suppressing plasma viral load is likely to reduce risk of HIV transmission to insertive partners.
authors.affiliation: Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. colleen.kelley@emory.edu
authors.forename: Colleen F
authors.initials: CF
authors.lastname: Kelley
authors.forename: Richard E
authors.initials: RE
authors.lastname: Haaland
authors.forename: Pragna
authors.initials: P
authors.lastname: Patel
authors.forename: Tammy
authors.initials: T
authors.lastname: Evans-Strickfaden
authors.forename: Carol
authors.initials: C
authors.lastname: Farshy
authors.forename: Debra
authors.initials: D
authors.lastname: Hanson
authors.forename: Kenneth
authors.initials: K
authors.lastname: Mayer
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Lennox
authors.forename: John T
authors.initials: JT
authors.lastname: Brooks
authors.forename: Clyde E
authors.initials: CE
authors.lastname: Hart
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000494:pharmacology; D001004:Anus Diseases / Q000473:pathology / Q000821:virology; D018791:CD4 Lymphocyte Count; D002690:Chlamydia Infections / Q000150:complications*; D002692:Chlamydia trachomatis; D004359:Drug Therapy, Combination; D006069:Gonorrhea / Q000150:complications*; D015658:HIV Infections / Q000150:complications / Q000821:virology*; D015497:HIV-1; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D009344:Neisseria gonorrhoeae; D012367:RNA, Viral / Q000032:analysis* / Q000097:blood; D019713:Receptors, CCR5 / Q000032:analysis / Q000097:blood; D019718:Receptors, CXCR4 / Q000032:analysis / Q000097:blood; D012007:Rectum / Q000737:chemistry / Q000821:virology*; D012044:Regression Analysis; D019562:Viral Load / Q000187:drug effects
chemical_list: D044966:Anti-Retroviral Agents; D012367:RNA, Viral; D019713:Receptors, CCR5; D019718:Receptors, CXCR4