title: Shedding of HIV and human herpesviruses in the semen of effectively treated HIV-1-infected men who have sex with men.
abstract: BACKGROUND
  Current antiretroviral therapy (ART) suppresses human immunodeficiency virus (HIV) in blood to undetectable levels in most infected individuals; however, some men shed HIV in semen despite suppressed levels in blood.
  
  
  METHODS
  This study included 114 chronically HIV type 1-infected men who have sex with men, who were receiving ART with blood plasma HIV <500 copies/mL. Asymptomatic participants were screened for bacterial sexually transmitted infections (STIs) and nonspecific genital inflammation. Levels of HIV and 7 human herpesviruses were measured by real-time polymerase chain reaction in seminal plasma. Predictors of HIV seminal shedding were determined for the entire cohort, and on the subset of 100 subjects with blood plasma HIV <50 copies/mL.
  
  
  RESULTS
  Eleven subjects (9.6%) had detectable levels of seminal HIV (median, 2.1 log10 copies/mL), and 72 (63.2%) had at least 1 herpesvirus detected in their seminal plasma. Detectable levels of seminal HIV were present more often in persons with plasma HIV between 50 and 500 copies/mL compared to those <50 copies/mL (P values adjusted for false discovery rate [FDR] = 0.08). There was a trend for high-level cytomegalovirus (CMV; >4 log10 DNA copies/mL; FDR-adjusted P = .08), and presence of Epstein-Barr virus (FDR-adjusted P = .06) in semen to be associated with detectable seminal HIV levels. In a subanalysis of 100 subjects with blood plasma HIV <50 copies/mL, high levels of CMV in semen was the only significant predictor for seminal HIV shedding.
  
  
  CONCLUSIONS
  Low-level HIV replication in blood and high-level seminal CMV shedding, but not presence of asymptomatic STIs, is associated with seminal shedding of HIV in men receiving ART, conferring a potential risk for HIV transmission.
authors.affiliation: University of California, San Diego, La Jolla, CA 92093-0679, USA. gianella@ucsd.edu
authors.forename: Sara
authors.initials: S
authors.lastname: Gianella
authors.forename: Davey M
authors.initials: DM
authors.lastname: Smith
authors.forename: Milenka V
authors.initials: MV
authors.lastname: Vargas
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Little
authors.forename: Douglas D
authors.initials: DD
authors.lastname: Richman
authors.forename: Eric S
authors.initials: ES
authors.lastname: Daar
authors.forename: Michael P
authors.initials: MP
authors.lastname: Dube
authors.forename: Fan
authors.initials: F
authors.lastname: Zhang
authors.forename: Christina C
authors.initials: CC
authors.lastname: Ginocchio
authors.forename: Richard H
authors.initials: RH
authors.lastname: Haubrich
authors.forename: Sheldon R
authors.initials: SR
authors.lastname: Morris
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000821:virology*; D015497:HIV-1 / Q000302:isolation & purification*; D006564:Herpesviridae / Q000302:isolation & purification*; D006566:Herpesviridae Infections / Q000453:epidemiology* / Q000821:virology; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D010949:Plasma / Q000821:virology; D015995:Prevalence; D060888:Real-Time Polymerase Chain Reaction; D012661:Semen / Q000821:virology*; D017201:Virus Shedding
chemical_list: D044966:Anti-Retroviral Agents
keywords: HIV shedding; HIV transmission; antiretroviral therapy; cytomegalovirus; semen