HIV and human herpesviruses in the semen of effectively treated HIV-1 infected men who have sex with men

MedicalResearch.com eInterview with Dr. Sara Gianella Weibel, M.D.
Center For Aids Research (CFAR)
University of California San Diego
La Jolla CA, 92093-0679
Email: gianella@ucsd.edu

MedicalResearch.com: What are the main findings of the study?

Answer: In this study we evaluated a large number of seminal samples from HIV-infected sexually active gay men treated with antiretroviral therapy (ART) using an extensive battery of tests for viral and bacterial co-infections. Around 10% of enrolled subjects presented detectable levels of HIV RNA in semen despite being on suppressive ART.

We observed an association between isolated seminal HIV shedding and replication of cytomegalovirus and Epstein Barr virus in the genital tract suggesting that the presence of these viruses could play a role in HIV transmission in individuals on ART. Specifically, treated subjects with concomitant shedding of cytomegalovirus had almost 6 times more frequently detectable HIV RNA in semen than subjects without cytomegalovirus shedding. Similarly, the risk of HIV RNA shedding in semen was 5 times bigger if subjects were shedding also Epstein Barr virus. These findings have important implications for the development of strategies to reduce HIV transmission.

MedicalResearch.com: Were any of the findings unexpected?

Answer: Previous studies from our group and others, described an association between seminal replication of cytomegalovirus and Epstein Barr virus with HIV seminal shedding as well as HIV transmission in individuals with detectable HIV in blood plasma. From a public health perspective, it is crucial to understand if concurrent shedding of those viruses are associated with HIV shedding in semen of immunologically reconstituted and virologically controlled individuals.

MedicalResearch.com: What should clinicians and patients take away from your report?

Answer: Even if patients are well suppressed on ART, there is still a proportion of patients with intermitted HIV RNA shedding in genital secretion potentially contributing to HIV transmission. While the treatment of bacterial sexually transmitted infections is a recognized strategy to reduce HIV-transmission, given our recent observation, an additional strategy might be the suppression of asymptomatic viral co-infections in the genital tract, especially cytomegalovirus. This needs to be proven in future studies (see below).

In any case, the most important strategy to prevent HIV transmission is to always practice safe sex regardless of the treatment status of the sexual partner.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Answer: Future studies are necessary to demonstrate that treatment of asymptomatic viral co-infections is associated with reduction of HIV transmission. Additionally, since we only included gay men in this study, it needs to be determined if this remains true for heterosexual individuals.

Citation:

HIV and human herpesviruses in the semen of effectively treated HIV-1 infected men who have sex with men

Sara Gianella, Davey M. Smith, Milenka V. Vargas, Susan J. Little, Douglas D. Richman, Eric S. Daar, Michael P. Dube, Fan Zhang, Christina C. Ginocchio, Richard H. Haubrich, Sheldon R. Morris, and the CCTG 592 Team

Clin Infect Dis. first published online April 17, 2013 doi:10.1093/cid/cit252

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