HIV Can Remain in Semen Despite Antiretroviral Treatment

Semen can still test positive for HIV infection despite low viral loads in blood, according to the findings of a new study presented at the 2017 American Urological Association Annual Meeting.

The study included blood and semen samples provided by 230 HIV-infected men who underwent semen screening from 2012 to 2015. The data included antiretroviral drug therapy, blood levels of HIV RNA and CD4+ lymphocytes, and semen levels of HIV RNA or HIV proviral DNA.
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Undetectable levels of HIV RNA in the blood was found in all men on antiretroviral therapy. However, 112 (18%) of semen specimens tested positive for the virus and 81 (35%) of men produced at least 1 HIV positive sample. The average CD4 cell blood count in men who produced HIV positive semen samples was not significantly different from the men who did not produce positive semen samples (634 vs 683, respectively).

Of the 14 men not on antitretroviral therapy due to persistently low blood virus levels, 10 produced at least 1 positive semen sample with 13 (36%) of the 36 specimens testing positive for HIV.

Out of the 137 men taking combinations of reverse transcriptase inhibitors, 28 (20%) produced at least 1 HIV-positive specimen, with 74 (18%) of the total 403 samples in the treatment group testing positive.

Nine (23%) of the 39 men whose treatment regimen included a protease inhibitor had at least 1 HIV-positive sample, with 11 (10%) of the 107 specimens testing positive.

In addition, 18 (41%) of the 44 men whose treatment included an integrase inhibitor with no protease inhibitor had at least 1 HIV-positive specimen, with 23 (18%) of the 128 samples testing positive for HIV.

“Current antiretroviral treatment strategies do not eliminate HIV from semen as effectively as they eliminate HIV RNA in blood,” the researchers concluded. “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.”

—Melissa Weiss

Reference:

Eyre R and Kiessling A. Current anti-retroviral treatments do not eliminate HIV from semen. Presented at: the 2017 American Urological Association Annual Meeting; May 12-16, 2017; Boston, MA. Abstract PNFLBA-01.