Vernazza P L, Troiani L, Flepp M J, Cone R W, Schock J, Roth F, Boggian K, Cohen M S, Fiscus S A, Eron J J
Department of Medicine, Kantonsspital St. Gallen, Switzerland.
AIDS. 2000 Jan 28;14(2):117-21. doi: 10.1097/00002030-200001280-00006.
The amount of HIV in semen likely influences infectiousness. Antiretroviral therapy decreases HIV-RNA in semen, but data on HIV concentrations in semen in a large cohort of men with suppressed HIV-RNA in blood is unavailable.
Male patients with a treatment-induced reduction of HIV-RNA load in plasma below 400 copies/ml were asked to donate a semen and blood sample. Blood and seminal plasma were tested for the presence of HIV-RNA by the NucliSens method (detection limit 400 copies/ml). Seminal cell samples from 67 patients were further analysed for the presence of HIV-DNA using a nested DNA-polymerase chain reaction. Results of RNA and DNA testing in semen were compared with 55 HIV-positive antiretroviral therapy-naive men.
A total of 114 patients participated in the study. Seminal plasma HIV-RNA was detectable in only two patients [1.8%, 95% confidence ratio (CI), 0-4.2%] compared with a detection frequency of 67% in untreated controls [Odds ratio (OR), 0.01; 95% CI, 0-0.03]. Detection of cell-associated HIV-DNA in semen was significantly less frequent (16 versus 38%) in patients receiving suppressive therapy compared with untreated controls (OR, 0.32; 95% CI, 0.12-0.80).
In patients with treatment-induced suppression of blood viral load the likelihood of having detectable HIV in semen is very low (< 4%). In addition, seminal shedding of cell-free and cell-associated HIV is significantly lower than in an untreated population of HIV-infected asymptomatic men. On a population basis, this effect of therapy may help to reduce sexual transmission of HIV. However, individual patients may still be infected as evidenced by continued shedding of cells harbouring the HIV provirus.
精液中的艾滋病毒数量可能影响传染性。抗逆转录病毒疗法可降低精液中的艾滋病毒核糖核酸（HIV-RNA），但缺乏关于一大群血液中HIV-RNA得到抑制的男性精液中HIV浓度的数据。
血浆中因治疗导致HIV-RNA负荷降至400拷贝/毫升以下的男性患者被要求捐献一份精液和一份血液样本。采用NucliSens方法（检测限为400拷贝/毫升）检测血液和精浆中是否存在HIV-RNA。使用巢式DNA聚合酶链反应对67例患者的精细胞样本进一步分析是否存在HIV-DNA。将精液中RNA和DNA检测结果与55例未接受过抗逆转录病毒治疗的HIV阳性男性进行比较。
共有114例患者参与了该研究。仅在2例患者中检测到精浆HIV-RNA[1.8%，95%置信比（CI），0-4.2%]，而未治疗对照组的检测频率为67%[优势比（OR），0.01；95%CI，0-0.03]。与未治疗对照组相比，接受抑制性治疗的患者精液中细胞相关HIV-DNA的检测频率显著降低（分别为16%和38%）（OR，0.32；95%CI，0.12-0.80）。
在因治疗导致血液病毒载量受到抑制的患者中，精液中可检测到HIV的可能性非常低（<4%）。此外，无细胞和细胞相关HIV的精液排出量显著低于未接受治疗的无症状HIV感染男性群体。从人群角度来看，这种治疗效果可能有助于减少HIV的性传播。然而，个别患者仍可能被感染，携带HIV前病毒的细胞持续排出就证明了这一点。
