Elsevier

Journal of Clinical Virology

Volume 109, December 2018, Pages 45-49
Journal of Clinical Virology

HIV-RNA decay in paired blood and semen samples of subjects receiving their first dolutegravir-based ART regimen

https://doi.org/10.1016/j.jcv.2018.11.002Get rights and content

Highlights

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    Dolutegravir suppressed HIV-RNA within the first 6 months of ART in naïve subjects.

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    A biphasic viral load decrease was observed in plasmatic and seminal compartments.

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    HIV-RNA decay was significantly faster in blood than in semen.

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    HIV-RNA seminal shedding was not related with clinical/viro-immunological features.

Abstract

Background and objectives

We aimed to investigate to what extent a first-line DTG-based ART regimen reduces HIV-RNA in semen compared to plasma.

Study design

In this prospective, observational study, ART-naïve, HIV-infected males starting their first ART regimen with DTG plus TDF/FTC or ABC/3TC were enrolled. Paired blood (BP) and seminal plasma (SP) samples were collected at baseline (T0) and at week-2/4/12/24 after ART initiation. Sexually transmitted infections (STI) were ruled out before enrolment.

Results

Median baseline HIV-RNA levels were lower in SP compared to BP (657 versus 38.200 copies/ml, p < 0.001), three subjects had undetectable semen HIV-RNA. After 12 weeks of treatment, HIV-RNA was below the quantification limit in both BP and SP of 11 pts (61.1%). Discordant results were obtained in 6 subjects (33.3%), showing quantifiable HIV-RNA in blood only (2 cases) and in semen only (4 cases). Finally, one subject had a positive HIV-RNA in SP/BP. At W24, only in 2/16 subjects (12.5%) HIV-RNA was detectable in semen, while in the others it was negative on SP/BP. No concurrent STI was found in subjects with detectable VL in semen.

Conclusions

DTG demonstrated effectiveness in reducing VL with different kinetics in blood and semen, despite seminal viral suppression after 6 months of ART was not obtained in the totality of subjects.

Section snippets

Background

Worldwide, around 2 million new HIV infections per year occur, the vast majority of which are sexually transmitted [1]. Antiretroviral therapy (ART) is highly effective at inhibiting viral replication both in plasmatic and genital compartments [2], thereby minimizing the risk of HIV transmission by sexual intercourses [3,4] with a decreased HIV incidence [5]. These evidences inspired the concept of “treatment as prevention” [6,7], therefore earlier initiation of ART is now recommended by

Objectives

We aimed to investigate whether and to what extent a first-line DTG-based ART regimen reduces HIV-RNA in semen compared to plasma. Variables potentially related to a delayed viral suppression in the genital compartment were also evaluated.

Study design

This was a prospective, observational study enrolling consecutive ART-naïve, HIV-1 infected males aged ≥ 18 years, attending the Clinic of Infectious Diseases, University of Bari (Italy), throughout the year 2016, who were about to initiate their first ART treatment. A DTG-based ART regimen was prescribed with a standard backbone: either tenofovir/emtricitabine (TDF/FTC) or abacavir/lamivudine (ABC/3TC). Sexually transmitted infections (STI) including chlamydia, gonorrhea, syphilis, and genital

Results

A total of 18 subjects were enrolled, with a median age of 33.5 years (range 18–57), most of whom (15 subjects, 83.3%) were men who have sex with men (MSM). At the time of their first HIV diagnosis, median CD4 cell count was 550 cell/mm3 (range 860-324), and 12 subjects (66.6%) belonged to CDC group A1. The majority of subjects (67%) were infected with a subtype B HIV-1, and 93.7% (15/16) harboured a R5 variant. CMV seroprevalence (available for 16/18 patients) was 72.2% (13 subjects). The

Discussion

A great deal of evidence from large cohorts of serodiscordant couples supports the role of effective ART in preventing the sexual transmission of HIV [19,20]. During the first six months of ART, although plasma viral load can be reduced, the risk of HIV transmission is greatly cut down, but not completely cancelled [21]. Whether this residual risk is related to a persistent HIV replication in the genital compartment [22] is a much-debated issue, and data regarding the ability of the most recent

Funding

This work was supported by unconditional grant by ViiV Healthcare.

Competing interests

None declared.

Authors’ contribution statement

Claudia Fabrizio*: Conceptualization, Methodology, Data curation, Writing-original draft

Nicolò de Gennaro: Conceptualization, Investigation, Data curation, Visualization

Anna Volpe: Investigation, Resources, Data curation

Luigia Scudeller: Formal analysis, Data curation, Visualization

Antonella Lagioia: Investigation, Resources, Data curation

Katia Falasca: Investigation, Resources

Nicoletta Ladisa: Investigation, Resources

Gioacchino Angarano: Writing – Review & Editing, Supervision, Funding

Acknowledgements

Presented in part at the 16th European AIDS Conference, 25-27 October 2017, Milan, Italy (Oral Presentation PS1/5).

The authors would like to thank all patients who participated in the study. The authors also wish to thank Mrs Paulene Butts for her assistance in manuscript preparation.

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