Third International Congress Drug Therapy in HIV Infection 3-7 November 1996 Glasgow, UK

ANTIRETROVIRAL TREATMENT AND SHEDDING OF HIV IN SEMEN

P.L. Vemazza, B.L. Gilliam, M. Flepp, J.R. Dyer, R. Cone, A.C. Frank, S.A. Fiscus, M.A. Cohen, J.J. Eron
Medizinische Klinik, St. Gallen, and University of Zurich, Switzerland, and University of North Carolina at Chapel Hill, NC, USA. Tel: +41 71 494 2831, FAX +41 71 494 8114, email: pvemazza@bitcom.ch

Int Cong Drug Therapy HIV 1996 Nov 3-7;3:Abstract No. OP4.2
AIDS 1996, Vol. 10 (Suppl. 2);S13

oBJECTIVE: HIV is predominantly transmitted by sexual intercourse. Semen remains the most important vehicle for male-to-male and male-to-female transmission of the virus. The concentration of HIV in semen is likely to reflect the infectivity of an infected individual. This study was performed to demonstrate the impact of antiviral treatment on HIV shedding in semen.

METHODS: HIV infected individuals were treated with antiviral combination therapy. Blood plasma HIV-RNA concentration was measured at baseline and between week 8 and 13. HIV shedding in semen was measured by HIV-RNA detection in seminal plasma (NASBA) and quantitative HIV-coculture of seminal cells at the same time points. To compare the antiviral effect of HIV in blood with the effect on semen, the reduction of HIV-RNA in blood was compared with the reduction of the HIV shedding in semen. To calculate pre/post-treatment ratio, HIV-RNA values below the detection limit (1000 copies/ml) were handled by assuming the values of 999 RNA copies/mt.

RESULTS: Currently, 22 HIV positive patients have been treated for at least 8 weeks in the prospective study and 38 patients have entered the study. Results of 13 patients are currently available for analysis. Antiviral treatment consisted of combination of one or two nucleoside analogues with or without a protease inhibitor. Some patients were on a blinded study protocol.

The median reduction of HIV-RNA in blood of the first 13 patients was 1.0 log₁₀, RNA copies/ml (c/ml). HIV-RNA concentration in semen was reduced by 0.57 log₁₀,. Eight of 13 patients had a positive HIV seminal cell culture at entry. The reduction of the infectious HIV titer by cell culture post treatment was 0.3 log. The antiviral effect of treatment in semen compared to blood was more than ten times weaker in 5/13 patients and more than hundred times stronger in 2/13 patients. On average, the treatment effect on HIV-RNA in semen was 33% of the effect in blood, but the individual differences were highly divergent. The geometric mean of the ratio of HIV-drop in semen by HIV-drop in blood was 0.33 (95% CI 0.03-2.88,n.s.). Analysis of all patients will be presented.

CONCLUSIONS: Reduction of HIV-RNA in blood is associated with a drop of HIV-RNA in semen. However, the effect of treatment on semen is less pronounced than in blood and is subject to a much higher variability. With the development of more potent drugs, the treatment effect on HIV in genital secretions may be an important target for future studies.

Presenting author: P.L. Vemazza

1996-11-03
op4.2

Originally published in AIDS Volume 10, Supplement 2 and hosted with permission of the publisher Lippincott Williams & Wilkins, 250 Waterloo Road, London, SE1 8RD, UK. Tel: +44 (0)20 7981 0700 Fax: +44 (0) 7981 0701

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