Adherence to Antiretroviral Therapy and Persistence of HIV RNA in Semen

Paulo F. Barroso, Mauro Schechter, Phalguni Gupta, Clarisse Bressan, Antonieta Bomfim, Lee H. Harrison


J Acquir Immune Defic Syndr. 2003;32(3) 

In This Article

Abstract and Introduction

Context: Long-term adherence to antiretrovirals is critical for sustained virologic response to HIV therapy in blood. Although antiretroviral therapy (ART) reduces HIV seminal shedding, little is known about the relationship between adherence to ART and HIV suppression in semen.
Objective: To determine predictors of seminal HIV RNA suppression after 6 months of ART.
Design: Prospective observational cohort of 93 HIV-infected subjects before and after introduction of ART. Seminal HIV RNA was measured at baseline and 1, 2, 3, and 6 months after the introduction of therapy. Adherence to therapy was measured by self-report.
Setting: A large academic HIV reference center in Rio de Janeiro, Brazil.
Main Outcome Measure: Detectable HIV RNA in semen.
Results: In a multivariate logistic model with undetectable seminal HIV RNA after 6 months of therapy as the outcome variable, adjusting for baseline seminal viral load, both being adherent to therapy (OR = 11.8, P < 0.01) and using triple-drug ART (OR = 6.48, P = 0.04) were independently associated with seminal HIV RNA suppression.
Conclusions: Inability to adhere to therapy was strongly associated with persistent shedding of HIV RNA in semen. Measures to improve adherence are urgently needed to reduce the sexual spread of potentially drug-resistant HIV among subjects using antiretrovirals.

Sexual activity is the most important mode of HIV transmission worldwide.[1,2] Sexual transmission of HIV has been shown to be correlated with blood plasma HIV viral load[3] and is likely to be mediated through shedding of HIV in genital secretions; the concentrations of HIV RNA in both compartments correlate substantially.[4,5,6] Antiretroviral therapy (ART) has had a profound impact on HIV-related morbidity and mortality[7] and has been shown to reduce the concentration of HIV RNA in semen.[4,5,8] Because sexual transmission of HIV from semen is probably related to the seminal HIV inoculum, antiretrovirals may limit HIV sexual transmission. The effectiveness of ART is greatly related to patient adherence to therapy, however.[9,10]

The factors responsible for persistent shedding of HIV in semen among persons on therapy are not known. Despite substantial reductions in seminal and blood plasma HIV RNA, 38% of subjects on dual ART and 13% of subjects on triple ART in a previous study had detectable HIV RNA in semen after 6 months of therapy.[4] The purpose of the current study was to evaluate the predictors of persistent shedding of HIV in semen in these subjects.


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