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Men taking virologically suppressive ART have undetectable HIV in their pre-ejaculatory fluid
Michael Carter, 2016-05-11 06:30:00
undetectable in the pre-ejaculatory fluid of men taking suppressive
antiretroviral therapy, investigators from the United States report in the
online edition of AIDS. Approximately
a fifth of men with an undetectable viral load in their blood had low-level HIV
replication in their semen, but none were shedding virus in pre-ejaculate.
provides the first evidence that pre-ejaculatory sexual secretions in men on
[ART], unlike those from untreated men, do not contain detectable HIV,” comment
There is now
overwhelming evidence that men and women who are taking stable ART that
suppresses HIV in blood to undetectable levels are extremely unlikely to
transmit the virus to their sexual partners. However, persistent HIV replication
has been detected in the semen of men taking treatment that suppresses viral
load in blood.
HIV has been
detected in the pre-ejaculatory fluid – colloquially called pre-cum – of
HIV-infected men not on ART and also in pre-ejaculatory samples obtained from
ART-exposed monkeys. Pre-ejaculate is thought that to be a possible source of
Boston wanted to see if HIV-replication persists in pre-ejaculatory fluid in
the context of treatment that suppresses viral load in blood and also to
establish if there is a relationship between detectable viral load in semen and
viral shedding in pre-ejaculate.
Their study sample
comprised 60 men. All were sexually active and had been taking a stable
antiretroviral regimen for at least three months.
pre-ejaculate, semen and blood were provided for viral load quantification. The
men were also screened for urethral sexually transmitted infections (STIs),
urethritis and HSV infections.
Eight of the men
had detectable viral load in their blood (range, 80-640,000 copies/ml) and were
excluded from the principal analysis.
The remaining 52
men all had blood viral load below the limit of detection (40 copies/ml). Their
median age was 43 years, median CD4 cell count was 518 cells/mm3,
96% reported sex with other men, and 44% said they had had insertive
unprotected anal sex within the past three months. None of the patients had a
bacterial urethral STI, one had urethritis and one was shedding HSV-2 in semen.
Four of the men
with detectable HIV in their blood were also shedding virus in their semen,
viral load ranging between 40 and 96,000 copies/ml. One man in this group also
had detectable virus in his pre-ejaculate (2,400 copies/ml).
Of the 52 men with
undetectable viral load in their blood, ten (19%) had low level HIV replication
in their semen (59 to 800 copies/ml). However, none had virus in their
Both the patients
with urethritis and the individual with seminal HSV-2 both had detectable HIV
in their semen.
RNA was detected in semen of men on stable ART with undetectable blood viral
load, it was not detected in pre-ejaculatory secretions,” conclude the authors.
“These data indicate that pre-ejaculatory fluid may not contribute to HIV
transmission in men on ART, at least in men without genital infections.”