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9th Annual Conference Of The British HIV Association [BHIVA]24 – 26 April 2003, University of Manchester
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[AUTHOR(S):] S Taylor1,3, T Sadiq2, D White1, C Sabin2, P Cane1,3, S Drake1 and D Pillay2
1 .Birmingham Heartlands Hospital, Birmingham, 2 Royal Free and University College Medical School, University College London, and 3 University of Birmingham, UK
BHIVA Conf 2003 Apr 24-26;9:O2
BACKGROUND: We identified patients who shed HIV into their seminal plasma (SP) at levels in excess of their blood plasma (BP). We termed them 'seminal super-shedders' (SSS) of HIV-1 and postulate that they may represent a group at increased risk of transmitting HIV-1.
METHODS: 72 HIV +ve men not on therapy were enrolled. They produced matched BP and SP samples at the same time as undergoing tests for urethritis. Viral load was determined by NASBA. Variables considered were; age, CDC status, CD4 count, BP viral load (VL) >100,000 copies/ml and the presence of urethritis. SSS was defined as SPVL/BPVL ratio >1.
RESULTS: No men had BPVL <400 copies/ml. In contrast 22/72 (30%) had SPVL <400 copies/ml despite detectable BPVL (non-shedders). Men who shed virus into semen had significantly higher BPVL than nonshedders; 5.01 log10 copies/ml (range 3.4-6.3) versus 4.2 log10 copies/ml (3.0-5.5), P<0.0001. Nine met the SSS criteria. These had significantly higher SPVL compared with non-SSS; 5.6 log10 copies/ml (4.1-6.7) versus 3.4 log10 copies/ml (2.6-6.2), P<0.001. Their BPVL was not significantly different. SSS were generally older; 48 versus 35 years (P<0.02) and the presence of urethritis was significantly overrepresented in the SSS group: 3/9 (33%) versus 3/63 (4.8%) in other groups (P=0.02). BPVL >100,000, CD4 counts and CDC status were not significantly different between SSS and SS.
CONCLUSIONS: 12% of this cohort were SSS as defined by the reversed SP:BP ratio. We postulate that within these individuals viral replication is occurring locally within the genital tract. Furthermore, when virus is produced at a high concentrations, these individuals may have a high probability of transmitting HIV during sexual acts.
PRESENTING AUTHOR: S Taylor
030424
O2
Copyright © 2003 - British HIV Association (BHIVA) Reproduction of this abstract (other than one copy for personal reference) must be cleared through the BHIVA Organising Secretariat 1 Mountview Court, 310 Friern Barnet Lane, London N20 0LD