外周血单核细胞中的 HIV-1 DNA 水平和大麻使用与接受成功抗逆转录病毒治疗方案的男男性行为者精液中间歇性 HIV 脱落有关。

HIV-1 DNA levels in peripheral blood mononuclear cells and cannabis use are associated with intermittent HIV shedding in semen of men who have sex with men on successful antiretroviral regimens.

机构信息

Université Paris Descartes, EA 7327, Université Paris Descartes PRES Sorbonne Paris-Cité APHP, Unité Fonctionnelle de Thérapeutique en Immuno-Infectiologie, Centre Hospitalier Universitaire Hôtel-Dieu.

Université Paris Descartes, EA 7327, Université Paris Descartes PRES Sorbonne Paris-Cité APHP, Laboratoire de Microbiologie, Centre Hospitalier Universitaire Necker Enfants Malades, Paris.

出版信息

Clin Infect Dis. 2014 Jun;58(12):1763-70. doi: 10.1093/cid/ciu187. Epub 2014 Mar 18.

DOI:10.1093/cid/ciu187

PMID:24647014

Abstract

BACKGROUND

Few data exist on the efficacy of combined antiretroviral therapy (cART) in semen of human immunodeficiency virus type 1 (HIV-1) infected men who have sex with men (MSM) with sustained control of HIV replication in blood.

METHODS

HIV-1 infected MSM on successful cART for >6 months were enrolled. HIV-RNA was quantified in seminal plasma (spVL) and in blood plasma (bpVL) from 2 paired samples collected 4 weeks apart. Relationship between spVL and bpVL (measured by an ultrasensitive assay, LOQ 10 copies/mL), total peripheral blood mononuclear cells (PBMC)-associated HIV-DNA, sexually transmitted infections (STIs), and self-reported socio-behavioral characteristics was assessed using GEE logistic regression.

RESULTS

In total, 157 patients were included. Median time with bpVL <50 copies/mL was 3.3 years. spVL was detectable in 23/304 samples (prevalence 7.6%). Median spVL was 145 cp/mL (100-1475). spVL was detectable on the first, on the second, and on both samples in 5, 14, and 2 men, respectively. In sum, 33 individuals (21%) had STIs (asymptomatic in 24/33). Residual bpVL was undetectable by ultrasensitive assay in 225/300 samples (75%). After multivariable adjustments, PBMC-associated HIV-DNA (OR 2.6[1.2; 6.0], for HIV-DNA > 2.5 log10 cp/10(6) PBMC, P = .02), and cannabis use during sexual intercourse (OR 2.8[1.2; 6.7], P = .02) were the only factors associated significantly with spVL.

CONCLUSION

We show that HIV-RNA can be detected intermittently in semen of HIV-1 infected MSM despite successful cART. The size of blood HIV-1 reservoir predicted spVL detection. Our results indicated also that the possible effect of cannabis should be taken into account when developing prevention interventions targeted toward HIV-infected MSM on successful cART.

摘要

背景

在血液中 HIV 复制得到持续控制的情况下，针对与男性发生性行为的 HIV-1 感染者（MSM），联合抗逆转录病毒治疗（cART）的疗效数据十分有限。

方法

招募接受成功 cART 治疗超过 6 个月的 HIV-1 感染 MSM。从 4 周间隔采集的 2 对样本中分别定量检测精液（spVL）和血浆（bpVL）中的 HIV-RNA。使用广义估计方程（GEE）逻辑回归评估 spVL 与 bpVL（通过超灵敏检测，定量下限为 10 拷贝/ml）、外周血单核细胞（PBMC）相关 HIV-DNA、性传播感染（STIs）和自我报告的社会行为特征之间的关系。

结果

共纳入 157 名患者。bpVL<50 拷贝/ml 的中位时间为 3.3 年。在 304 个样本中，23 个样本（检出率为 7.6%）检测到 spVL。spVL 的中位数为 145 cp/ml（100-1475）。spVL 首次、再次和均能检出的样本数分别为 5、14 和 2 个。总共 33 名（21%）患者患有 STIs（无症状 24/33）。225/300 个样本（75%）经超灵敏检测无法检出残留的 bpVL。经多变量调整后，PBMC 相关 HIV-DNA（比值比 2.6[1.2; 6.0]，HIV-DNA>2.5 log10 cp/10(6) PBMC，P=0.02）和性交时使用大麻（比值比 2.8[1.2; 6.7]，P=0.02）是与 spVL 显著相关的唯一因素。