Department of Medicine, University of Washington, Seattle, Washington, United States of America.
PLoS One. 2012;7(8):e43086. doi: 10.1371/journal.pone.0043086. Epub 2012 Aug 13.
Antiretroviral therapy (ART) decreases HIV-1 RNA levels in semen and reduces sexual transmission from HIV-1-infected men. Our objective was to study the time course and magnitude of seminal HIV-1 RNA decay after initiation of efavirenz-based ART among 13 antiretroviral-naïve Kenyan men.
HIV-1 RNA was quantified (lower limit of detection, 120 copies/mL) in blood and semen at baseline and over the first month of ART. Median log(10) HIV-1 RNA was compared at each time-point using Wilcoxon Signed Rank tests. Perelson's two-phase viral decay model and nonlinear random effects were used to compare decay rates in blood and semen.
Median baseline HIV-1 RNA was 4.40 log(10) copies/mL in blood (range, 3.20-5.08 log(10) copies/mL) and 3.69 log(10) copies/mL in semen (range, <2.08-4.90 log(10) copies/mL). The median reduction in HIV-1 RNA by day 28 was 1.90 log(10) copies/mL in blood (range, 0.56-2.68 log(10) copies/mL) and 1.36 log(10) copies/mL in semen (range, 0-2.66 log(10) copies/mL). ART led to a decrease from baseline by day 7 in blood and day 14 in semen (p = 0.005 and p = 0.006, respectively). The initial modeled decay rate was slower in semen than in blood (p = 0.06). There was no difference in second-phase decay rates between blood and semen.
Efavirenz-based ART reduced HIV-1 RNA levels more slowly in semen than in blood. Although this difference was of borderline significance in this small study, our observations suggest that there is suboptimal suppression of seminal HIV-1 RNA for some men in the early weeks of treatment.
抗逆转录病毒疗法（ART）可降低精液中 HIV-1 RNA 水平，并降低 HIV-1 感染男性的性传播风险。我们的目的是研究 13 名肯尼亚初治抗逆转录病毒药物的男性接受依非韦伦为基础的 ART 后精液中 HIV-1 RNA 衰减的时间过程和幅度。
在基线和 ART 治疗的第一个月，分别定量检测血液和精液中的 HIV-1 RNA（检测下限为 120 拷贝/ml）。采用 Wilcoxon 符号秩检验比较各时间点的中位对数（10）HIV-1 RNA。采用 Perelson 两阶段病毒衰减模型和非线性随机效应比较血液和精液中的衰减率。
中位基线 HIV-1 RNA 血液水平为 4.40 对数（10）拷贝/ml（范围，3.20-5.08 对数（10）拷贝/ml），精液水平为 3.69 对数（10）拷贝/ml（范围，<2.08-4.90 对数（10）拷贝/ml）。第 28 天 HIV-1 RNA 中位数降低了 1.90 对数（10）拷贝/ml（范围，0.56-2.68 对数（10）拷贝/ml），精液中降低了 1.36 对数（10）拷贝/ml（范围，0-2.66 对数（10）拷贝/ml）。第 7 天血液中，第 14 天精液中，ART 治疗后 HIV-1 RNA 水平均低于基线（p = 0.005 和 p = 0.006）。初始模型显示，精液中的衰减速度比血液慢（p = 0.06）。血液和精液中的第二阶段衰减率没有差异。
依非韦伦为基础的 ART 降低精液中 HIV-1 RNA 水平的速度比血液慢。尽管在这项小型研究中，这种差异具有边缘显著性，但我们的观察结果表明，在治疗的早期，一些男性的精液 HIV-1 RNA 抑制效果不理想。
