Division of Reproductive Biology, Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA 02118, USA.
AIDS. 2012 Jul 31;26(12):1535-43. doi: 10.1097/QAD.0b013e328353b11b.
Although HAART can suppress genital shedding and sexual transmission of HIV, men who have sex with men (MSM) have experienced a resurgent HIV epidemic in the HAART era. Many HIV-infected MSM continue to engage in unsafe sex, and sexually transmitted infections (STIs) or other factors may promote genital HIV shedding and transmission in this population despite HAART. In this study, we determined the prevalence of seminal HIV shedding in HIV-infected MSM on stable HAART, and its relationship with a number of clinical, behavioral and biological variables.
Sexually active HIV-infected men using HAART were recruited from an MSM health clinic to provide semen and blood samples.
HIV levels were assessed in paired semen and blood samples by PCR. Clinical and behavioral data were obtained from medical records and questionnaires. Herpes simplex virus 2 (HSV-2) serostatus, seminal HSV-2 DNA, and markers of genital inflammation were measured using standard laboratory methods.
Overall, HIV-1 was detected in 18 of 101 (18%) blood and 30 of 101 (30%) semen samples. Of 83 men with undetectable HIV in blood plasma, 25% had HIV in semen with copy numbers ranging from 80 to 2560. Multivariate analysis identified STI/urethritis (P = 0.003), tumor necrosis factor α (P = 0.0003), and unprotected insertive anal sex with an HIV-infected partner (P = 0.007) as independent predictors of seminal HIV detection.
STIs and genital inflammation can partially override the suppressive effect of HAART on seminal HIV shedding in sexually active HIV-infected MSM. Low seminal HIV titers could potentially pose a transmission risk in MSM, who are highly susceptible to HIV infection.
尽管高效抗逆转录病毒治疗（HAART）可抑制艾滋病毒的生殖器脱落和性传播，但男男性行为者（MSM）在 HAART 时代经历了艾滋病毒疫情的死灰复燃。许多感染艾滋病毒的 MSM 继续进行不安全的性行为，而性传播感染（STI）或其他因素可能会促进该人群中尽管接受 HAART 治疗但仍存在的生殖器 HIV 脱落和传播。在这项研究中，我们确定了在接受稳定 HAART 治疗的 HIV 感染 MSM 中精液 HIV 脱落的流行率，及其与许多临床、行为和生物学变量的关系。
从 MSM 健康诊所招募正在接受 HAART 的活跃 HIV 感染男性，以提供精液和血液样本。
通过 PCR 评估配对的精液和血液样本中的 HIV 水平。从病历和问卷中获取临床和行为数据。使用标准实验室方法测量单纯疱疹病毒 2（HSV-2）血清状态、精液 HSV-2 DNA 和生殖器炎症标志物。
总体而言，在 101 份血液样本中有 18 份（18%）和 101 份精液样本中有 30 份（30%）检测到 HIV-1。在 83 名血浆中 HIV 不可检测的男性中，25%的人精液中有 HIV，拷贝数范围为 80 至 2560。多变量分析确定性传播感染/尿道炎（P = 0.003）、肿瘤坏死因子-α（P = 0.0003）和与 HIV 感染伴侣进行无保护的插入性肛交（P = 0.007）是精液 HIV 检测的独立预测因素。
STIs 和生殖器炎症可能部分抵消了高效抗逆转录病毒治疗对活跃的 HIV 感染 MSM 精液中 HIV 脱落的抑制作用。低精液 HIV 滴度可能会对 HIV 感染高度易感染的 MSM 构成传播风险。
