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