Was the Following to Be Expected?
CROI 2009: High Semen HIV RNA When Plasma is Undetectable
Bob Roehr
February 10, 2009 (Montreal, Quebec) – The belief that undetectable plasma HIV RNA means lower risk of viral transmission through seminal fluid may hold true on a population level, but not when applied at the individual height, according to new data presented here at the 16th Conference on Retroviruses and Opportunistic Infections.
Prameet Sheth, MD, from the University of Toronto, in Ontario, and colleagues conducted a longitudinal study within a cohort of 25 participants who were initiating highly involved antiretroviral therapy (HAART). They were seen every 2 weeks for the first month, afterwards monthly for 5 months. HIV RNA became undetectable in blood for all of them by week 16, but nearly partly (48%) still had detectable virus in their seminal fluid.
Some of the lower levels of viremia imagined did not have clinical significance, nor did they pose substantial risk of transmission. But 4 of the 25 (16%) participants surpassed 5000 copies/mL, and 1 reach 16,000 copies/mL of HIV RNA, which was cause for concern. One patient completely suppressed plasma viremia inside 4 weeks of starting therapy but "was a sustained semen shedder" out to the end of the 6-month study.
Answers:
Possibly. Though I wonder where on earth the viral particles are coming from. There aren't any CD4+ cells in the semen itself - so in attendance must be some nearby. Perhaps Langerhans cells or other dendritics line the plumbing within there.
Anyway. There's always going to be a certain amount of individual oscillation - on the grand scale of things lower plasma levels of HIV may penny-pinching reduced transmission, but for an individual that's not always going to be the case. These sorts of generalization need to be characterized, and more importantly someone has to actually study them to see how they look within the real world.
Also, I'd like to see more than n=25 for christ's sake. That's okay for a tiny little investigation, but not enough to generalize to even a smallish population.
Oh yeah. I guess that should've be expected.
I don't know that "expected" would be the correct word, but it might not be that surprising, when you think about it - between anti-retroviral drugs and the immune system killing infected cell, the plasma load would certainly be low; the testis are immunologically privileged sites, so I think it's defensible that in a subset of people, you'd see virus remaining somewhere in the reproductive system (it might not hold any immune cells to infect there, but on the flip side, it's not getting killed either). Bottom row is, like anything else, the virus will try to find some way/somewhere to survive; it's just good that this research is uncovering latest information that will hopefully lead to even more effective treatment.
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Bob Roehr
February 10, 2009 (Montreal, Quebec) – The belief that undetectable plasma HIV RNA means lower risk of viral transmission through seminal fluid may hold true on a population level, but not when applied at the individual height, according to new data presented here at the 16th Conference on Retroviruses and Opportunistic Infections.
Prameet Sheth, MD, from the University of Toronto, in Ontario, and colleagues conducted a longitudinal study within a cohort of 25 participants who were initiating highly involved antiretroviral therapy (HAART). They were seen every 2 weeks for the first month, afterwards monthly for 5 months. HIV RNA became undetectable in blood for all of them by week 16, but nearly partly (48%) still had detectable virus in their seminal fluid.
Some of the lower levels of viremia imagined did not have clinical significance, nor did they pose substantial risk of transmission. But 4 of the 25 (16%) participants surpassed 5000 copies/mL, and 1 reach 16,000 copies/mL of HIV RNA, which was cause for concern. One patient completely suppressed plasma viremia inside 4 weeks of starting therapy but "was a sustained semen shedder" out to the end of the 6-month study.
Answers:
Possibly. Though I wonder where on earth the viral particles are coming from. There aren't any CD4+ cells in the semen itself - so in attendance must be some nearby. Perhaps Langerhans cells or other dendritics line the plumbing within there.
Anyway. There's always going to be a certain amount of individual oscillation - on the grand scale of things lower plasma levels of HIV may penny-pinching reduced transmission, but for an individual that's not always going to be the case. These sorts of generalization need to be characterized, and more importantly someone has to actually study them to see how they look within the real world.
Also, I'd like to see more than n=25 for christ's sake. That's okay for a tiny little investigation, but not enough to generalize to even a smallish population.
Oh yeah. I guess that should've be expected.
I don't know that "expected" would be the correct word, but it might not be that surprising, when you think about it - between anti-retroviral drugs and the immune system killing infected cell, the plasma load would certainly be low; the testis are immunologically privileged sites, so I think it's defensible that in a subset of people, you'd see virus remaining somewhere in the reproductive system (it might not hold any immune cells to infect there, but on the flip side, it's not getting killed either). Bottom row is, like anything else, the virus will try to find some way/somewhere to survive; it's just good that this research is uncovering latest information that will hopefully lead to even more effective treatment.
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