Persistence of Human Immunodeficiency Virus in Semen After Adding Indinavir to Combination Antiretroviral Therapy

• Published in: Clinical infectious diseases 1999-06, Vol.28 (6), p.1252-1259
• Main Authors: Mayer, Kenneth H., Boswell, Stephen, Goldstein, Robert, Lo, Wilson, Xu, Chong, Tucker, Lynne Tucke, DePasquale, Maria Pia, D'Aquila, Richard, Anderson, Deborah J.
• Format: Article
• Language: English
• Subjects: AIDS/HIV; Anti-HIV Agents - administration & dosage; Antiretrovirals; Blood; Blood cells; Blood plasma; CD4 Lymphocyte Count; Clinical Articles; DNA; DNA, Viral - analysis; Drug Therapy, Combination; HIV; HIV 1; HIV Protease - genetics; HIV Protease Inhibitors - administration & dosage; HIV-1 - drug effects; HIV-1 - isolation & purification; Humans; Indinavir - administration & dosage; Longitudinal Studies; Male; Polymerase chain reaction; RNA; RNA, Viral - analysis; Semen - virology; Viral load
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/514775

Changes in human immunodeficiency virus (HIV) type 1 concentration and protease genotype were evaluated in semen specimens from 22 HIV-positive men before and 6 months after the addition of indinavir to dual nucleoside therapy. Seminal HIV was detected by polymerase chain reaction analysis for DNA or RNA for 59% of men before combination treatment and persisted at 6 months for 31% of the men who initially had seminal HIV detected (P = .026). The maximum levels of cell-free RNA, cell-associated RNA, and proviral DNA in semen before treatment and at 6 months were 400,000 and 10,000 copies/mL, 70,000 and 27,000 copies/mL, and 80,000 and 3,000 copies/mL, respectively. Three of the four men with persistent seminal DNA had plasma viral loads of .10,000 copies/mL before treatment. One patient who became intolerant to indinavir had seminal HIV RNA detected by PCR analysis after 6 months. Although none of the cultures of semen specimens from the four men with PCR analysis-detectable seminal DNA after 6 months yielded HIV, indinavir resistance mutations were identified in a seminal leukocyte DNA specimen from one patient, and a second patient whose therapy was switched to saquinavir had different protease inhibitor resistance mutations in seminal and blood leukocyte DNA specimens. HIV-1 protease inhibitor resistance mutants may emerge in the semen of patients receiving combination therapy.