Plenary: Next Frontier, Sunday
Plenary: Next Frontier
Presentation Authors: Robert Eyre*, Needham, MA, Ann Kiessling, Bedford, MA
Introduction: Infected semen fuels the HIV pandemic. Despite the development of highly effective anti-retroviral drugs, more than 30,000 new cases are diagnosed annually in the U.S., only a 10% drop since 2005. Although it is recognized that semen infection is compartmentalized from blood, little is known about infection sites or effective treatment for semen HIV. To begin to develop treatment guidelines to eliminate HIV from semen, we have examined semen virus detection according to treatment regimen of HIV-infected men.
Methods: Review of a recently compiled blinded dataset of antiretroviral drug therapy, blood levels of HIV RNA and CD4+ lymphocytes, and HIV RNA or HIV proviral DNA in semen specimens submitted by 230 HIV-infected men undergoing semen screening from 2012 to 2015. Semen HIV was detected by RT-PCR.
Results: All men on antiretroviral therapy had undetectable levels of HIV RNA in blood. Overall, 112 (18%) of the specimens tested positive for virus, with 81 (35%) of men producing at least one positive specimen. Ten of fourteen men not on antiretroviral therapy because of persistently low blood virus levels produced at least one positive semen specimen with 13 (36%) of 36 specimens testing positive for HIV.
Average CD 4 blood count (634) for men producing positive semen specimens was not significantly different from those producing no HIV-positive semen specimens (683).
Twenty eight (20%) of the 137 men taking combinations of reverse transcriptase inhibitors produced at least one HIV-positive semen specimen; of the total of 403 specimens in this treatment group, 74 (18%) were positive.
Nine (23%) of the 39 men whose treatment regimen included a protease inhibitor produced at least one positive specimen, with only 11 (10%) of the total of 107 specimens in this group testing HIV positive.
Eighteen (41%) of the 44 men whose treatment included an integrase inhibitor with no protease inhibitor produced at least one positive specimen, with 23 (18%) of the total of 128 specimens testing HIV positive.
Conclusions: Current antiretroviral treatment strategies do not eliminate HIV from semen as effectively as they eliminate HIV RNA in blood. These findings suggest anti-viral combinations containing a protease inhibitor may be more effective in reducing HIV in semen. A larger study cohort is urgently needed to test this possibility.
Source Of Funding: None
Harvard Medical School
Robert C. Eyre, M.D. is an Associate Professor of Surgery (Urology) at Harvard Medical School. He is the former chief of urology of the New England Deaconess Hospital and former chief of clinical urology at Beth Israel Deaconess Medical Center in Boston. He is currently chief of urology at Beth Israel Deaconess Needham, Needham, MA.
Sunday, May 14
11:00 AM – 11:05 AM