Timing of Intermittent Seminal HIV-1 RNA Shedding in Patients with Undetectable Plasma Viral Load under Combination Antiretroviral Therapy

Ferraretto, Xavier; Estellat, Candice; Damond, Florence; Longuet, P; Epelboin, Sylvie; Demailly, P.; Yazbeck, Chadi; Llabador, Marie-Astrid; Pasquet, Blandine; Yazdanpanah, Yazdan; Matheron, Sophie; Patrat, Catherine

doi:10.1371/journal.pone.0088922

Cited by 23 publications

(18 citation statements)

References 19 publications

(22 reference statements)

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“…). Seminal viral shedding of HIV may be associated with co‐infection such as cytomegalovirus , genital inflammations , differences in blood viral loads , ART regimen or duration of ART . In the current study, the undetectable seminal viral load we found after ART may be attributable to the relatively longer duration of ART, which differs from our previous study with only 6 months of ART .…”

Section: Discussioncontrasting

confidence: 92%

“…In the current study, the undetectable seminal viral load we found after ART may be attributable to the relatively longer duration of ART, which differs from our previous study with only 6 months of ART . Our result is consistent with those of previous studies for 6 months or more than 3 years of ART . Further studies are still needed to confirm our results in more patients receiving prolonged ART and over more intervals.…”

Section: Discussionsupporting

confidence: 81%

See 1 more Smart Citation

After 18 months of antiretroviral therapy, total HIV DNA decreases more pronouncedly in patients infected by CRF01_AE than in those infected by subtype B and CRF07_BC

Jiao

et al. 2018

Microbiology and Immunology

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Whether the amount of HIV DNA is associated with the subtype of HIV-1 after antiretroviral therapy (ART) has not been reported. In the present study, the amount of HIV DNA and RNA and CD4+T counts in blood and semen prior to and after 18 months of ART were compared in 48 patients infected by CRF01_AE, subtype B or CRF07_BC of HIV-1. Viral RNA was suppressed and CD4 cell count recovery achieved in all patients. The level of HIV DNA were similar before ART; however, patients with CRF01_AE had less HIV DNA after ART than those with subtype B and CRF07_BC infection. According to prediction of co-receptor usage by Geno2Pheno and PSSM in combination, more than 35.6% of clones for CRF01_AE were predicted as CXCR4-using before ART, whereas less than 6% of those for subtype B and CRF07_BC were predicted as CXCR4-using. After 18 months of ART, no CXCR4-using clones were predicted in any of the subtypes. Despite more HIV RNA and fewer CD4 + T cells in patients with CRF01_AE before therapy, no significant differences (P > 0.05) in viral RNA or CD4 cell counts were observed between the subtypes after 18 months of ART. Thus, 18 months of antiretroviral therapy was more efficient in patients with CRF01_AE. Considering that successful ART dramatically reduces the viral load in both blood and semen, risks of sexual transmission of HIV were reduced, contributing to prevention of rapid spread of HIV among men who have sex with men in the region.

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Section: Discussioncontrasting

confidence: 92%

Section: Discussionsupporting

confidence: 81%

After 18 months of antiretroviral therapy, total HIV DNA decreases more pronouncedly in patients infected by CRF01_AE than in those infected by subtype B and CRF07_BC

Jiao

et al. 2018

Microbiology and Immunology

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“…[9,26–28] In our study, we found an absolute correlation between viral load in blood and in semen: in 100% of the men with undetectable plasma viral load on ART, it was also undetectable in semen. It should be noted that our study involved exhaustive screening of and treatment for genitourinary infections before determining the viral load in semen.…”

Section: Discussionmentioning

confidence: 66%

“…[29,30] It has been pointed intermittent that seminal shedding of HIV (RNA) in spite of suppression of HIV in blood and persistence of HIV DNA in semen should not be considered to place individuals at greater risk for HIV transmission than previously reported. [26,30] So some of the limitations we used in the early years of our program could be dropped in future.…”

Section: Discussionmentioning

confidence: 99%

Natural conception in HIV-serodiscordant couples with the infected partner in suppressive antiretroviral therapy

et al. 2016

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The potential of antiretroviral treatment (ART) to prevent the sexual transmission of HIV has increased the number of serodiscordant couples who are considering natural conception. We aim to describe the results of a protocol for reproductive counseling aimed at HIV serodiscordant couples who desire natural conception, in which the infected partner, the index case, is receiving suppressive antiretroviral treatment.A prospective cohort included all HIV serodiscordant couples attended a counseling program in the period 2002 to 2013 who opted for natural conception and met the following criteria: index case on ART with persistent plasma viral suppression for at least the previous 6 months, ART compliance over 95%, preserved immune status, undetectable HIV viral and proviral load in semen in male index cases, and absence of genitourinary infections and fertility problems in both members of the couple.Of the 161 HIV serodiscordant couples included, 133 with male index cases, 66% achieved at least 1 pregnancy, 18% a second one, and 5% a third pregnancy. A total of 144 natural pregnancies occurred and 107 babies were born. The pregnancy rate was 1.9 for each 100 acts of vaginal intercourse, and the mean time to conception was 6.1 months, both independently of the sex of the index case. No case of sexual or vertical HIV transmission occurred.In the absence of fertility problems and under controlled conditions, natural conception might be a safe and effective reproductive method for those HIV serodiscordant couples who choose this reproductive option.

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“…For example, in sub-Saharan Africa it is estimated that at least one-third of individuals who have been taking antiretrovirals for 12 months do not attain viral suppression (34). Furthermore, up to 48% of men taking effective antiretroviral therapy with undetectable viral load in blood plasma samples have detectable virus in their semen (35, 36). Semen washing may be relevant in such settings where men can access antiretroviral therapy and are highly adherent to it, but remain at risk of transmitting HIV to their partners.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of semen washing to prevent human immunodeficiency virus (HIV) transmission and assist pregnancy in HIV-discordant couples: a systematic review and meta-analysis

Zafer

Horváth

Mmeje

et al. 2016

Fertility and Sterility

106

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Objective To evaluate the effectiveness of semen washing in HIV-discordant couples in which the male partner is infected Design Systematic review and meta-analysis Setting All countries Patient(s) Forty single-arm, open label studies among HIV-discordant couples that underwent intrauterine insemination (IUI) or in vitro fertilization (IVF) with or without intracytoplasmic sperm injection (ICSI) using washed semen Intervention(s) Semen washing followed by IUI, IVF, or IVF/ICSI Main outcome measure(s) Primary outcome: HIV transmission to HIV-uninfected women; secondary outcomes: HIV transmission to newborns and proportion of couples achieving a clinical pregnancy Result(s) No HIV transmission occurred in 11,585 cycles of assisted reproduction using washed semen among 3,994 women (95% confidence interval [CI] = 0–0.0001). Among the subset of HIV-infected men without plasma viral suppression at the time of semen washing, no HIV seroconversions occurred among 1,023 women following 2,863 cycles of assisted reproduction using washed semen (95%CI= 0–0.0006). Studies that measured HIV transmission to infants reported no cases of vertical transmission (0/1,026, 95% CI= 0–0.0029). Overall, 56.3% (2,357/4,184, 95%CI=54.8%–57.8%) of couples achieved a clinical pregnancy using washed semen. Conclusion(s) Semen washing appears to significantly reduce the risk of transmission in HIV-discordant couples desiring children, regardless of viral suppression in the male partner. There are no randomized, controlled studies or studies from low-income countries, especially those with a large burden of HIV. Continued development of lower-cost semen washing and assisted reproduction technologies is needed. Integration of semen washing into HIV prevention interventions could help further reduce the spread of HIV.

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Timing of Intermittent Seminal HIV-1 RNA Shedding in Patients with Undetectable Plasma Viral Load under Combination Antiretroviral Therapy

Cited by 23 publications

References 19 publications

After 18 months of antiretroviral therapy, total HIV DNA decreases more pronouncedly in patients infected by CRF01_AE than in those infected by subtype B and CRF07_BC

After 18 months of antiretroviral therapy, total HIV DNA decreases more pronouncedly in patients infected by CRF01_AE than in those infected by subtype B and CRF07_BC

Natural conception in HIV-serodiscordant couples with the infected partner in suppressive antiretroviral therapy

Effectiveness of semen washing to prevent human immunodeficiency virus (HIV) transmission and assist pregnancy in HIV-discordant couples: a systematic review and meta-analysis

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