title: Highly active antiretroviral therapy does not completely suppress HIV in semen of sexually active HIV-infected men who have sex with men.
abstract: OBJECTIVE
  Although HAART can suppress genital shedding and sexual transmission of HIV, men who have sex with men (MSM) have experienced a resurgent HIV epidemic in the HAART era. Many HIV-infected MSM continue to engage in unsafe sex, and sexually transmitted infections (STIs) or other factors may promote genital HIV shedding and transmission in this population despite HAART. In this study, we determined the prevalence of seminal HIV shedding in HIV-infected MSM on stable HAART, and its relationship with a number of clinical, behavioral and biological variables.
  
  
  METHODS
  Sexually active HIV-infected men using HAART were recruited from an MSM health clinic to provide semen and blood samples.
  
  
  METHODS
  HIV levels were assessed in paired semen and blood samples by PCR. Clinical and behavioral data were obtained from medical records and questionnaires. Herpes simplex virus 2 (HSV-2) serostatus, seminal HSV-2 DNA, and markers of genital inflammation were measured using standard laboratory methods.
  
  
  RESULTS
  Overall, HIV-1 was detected in 18 of 101 (18%) blood and 30 of 101 (30%) semen samples. Of 83 men with undetectable HIV in blood plasma, 25% had HIV in semen with copy numbers ranging from 80 to 2560. Multivariate analysis identified STI/urethritis (P = 0.003), tumor necrosis factor α (P = 0.0003), and unprotected insertive anal sex with an HIV-infected partner (P = 0.007) as independent predictors of seminal HIV detection.
  
  
  CONCLUSIONS
  STIs and genital inflammation can partially override the suppressive effect of HAART on seminal HIV shedding in sexually active HIV-infected MSM. Low seminal HIV titers could potentially pose a transmission risk in MSM, who are highly susceptible to HIV infection.
authors.affiliation: Division of Reproductive Biology, Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA 02118, USA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Politch
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Mayer
authors.forename: Seth L
authors.initials: SL
authors.lastname: Welles
authors.forename: William X
authors.initials: WX
authors.lastname: O'Brien
authors.forename: Chong
authors.initials: C
authors.lastname: Xu
authors.forename: Frederick P
authors.initials: FP
authors.lastname: Bowman
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Anderson
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D003430:Cross-Sectional Studies; D016207:Cytokines / Q000097:blood; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D015497:HIV-1 / Q000302:isolation & purification*; D018258:Herpesvirus 2, Human / Q000302:isolation & purification; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012307:Risk Factors; D012661:Semen / Q000821:virology*; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014526:Urethritis / Q000453:epidemiology; D055815:Young Adult
chemical_list: D016207:Cytokines