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Basic Clin Androl. 2017 Sep 8;27:17. doi: 10.1186/s12610-017-0063-x. eCollection 2017.

Patterns of residual HIV-1 RNA shedding in the seminal plasma of patients on effective antiretroviral therapy.

Pasquier C1,2,3,4, Walschaerts M5,6, Raymond S1,2,3, Moinard N5,6, Saune K1,2,3, Daudin M5,6, Izopet J1,2,3, Bujan L5,6.

Author information

1
INSERM U1043, CPTP, CHU Purpan, BP 3028, F-31024 Toulouse, France.
2
Université de Toulouse, UPS, CPTP, F-31024 Toulouse, France.
3
Laboratoire de Virologie, CHU de Toulouse, Hôpital Purpan, F-31059 Toulouse, France.
4
Laboratoire de Virologie, Institut Fédératif de Biologie, 330 avenue de Grande Bretagne, TSA40031, 31059, Cédex 9 Toulouse, France.
5
Université de Toulouse, UPS, Groupe de Recherche en Fertilité Humaine (EA 3694, Human Fertility Research Group), Toulouse, France.
6
CECOS Midi-Pyrénées, Hôpital Paule-de-Viguier, Toulouse, France.

Abstract

in English, French

BACKGROUND:

More and more HIV-1-infected men on effective antiretroviral treatment (ART) have unprotected sex in order to procreate. The main factor influencing transmission is seminal HIV shedding. While the risk of HIV transmission is very low, it is difficult to assess in individuals. Nevertheless, it should be quantified.

RESULTS:

We retrospectively analysed seminal plasma HIV-1 shedding by 362 treated HIV-infected men attending a medically assisted reproduction centre (1998-2013) in order to determine its frequency, the impact of the antiretroviral regimen on HIV shedding, and to identify shedding patterns. The HIV-1 virus loads in 1396 synchronized blood and semen samples were measured, and antiretroviral treatment, biological and epidemiological data were recorded. We detected isolated HIV-1 shedding into the seminal plasma in 5.3% of patients on efficient antiretroviral treatment, but there was no association with the HIV antiretroviral drug regimen or the CD4 cell count. These men had undergone more regimen changes since treatment initiation and had been on the ongoing drug regimen longer than the non-shedding men. The patterns of HIV seminal shedding among patients with undetectable HIV blood virus load varied greatly. HIV seminal shedding can occur as long as 5 years after starting antiretroviral treatment.

CONCLUSIONS:

The seminal HIV load was used to monitor risk for infertile HIV-infected patients on an assisted reproductive technology program. This can still be recommended for patients who recently (6 months) started ART, or those with a poor history of adherence to ART but may also be usefull for some patients during counselling. Residual HIV seminal shedding is probably linked to breaks in adherence to antiretroviral treatment but local genital factors cannot be ruled out.

KEYWORDS:

Antiretroviral treatment; HIV; Medically assisted reproduction; Semen; Sexual transmission; Sperm processing

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