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Deborah J. Anderson, PhD; Thomas R. O'Brien, MD, MPH; Joseph A. Politch, PhD; Adriana Martinez; George R. Seage III, DSc, MPH; Nancy Padian, PhD; C. Robert Horsburgh, Jr, MD; Kenneth H. Mayer, MD

JAMA. 1992;267(20):2769-2774.

Abstract
Objective.
—To determine the prevalence and temporal expression of infectious human immunodeficiency virus type 1 (HIV-1) in the semen of HIV-1 seropositive men and to determine whether the detection of HIV-1 in semen is associated with disease stage, zidovudine treatment status, or other clinical factors.

Design.
—A microculture technique was used to detect infectious HIV-1 in semen from a cohort of 95 seropositive men. In addition, semen cultures were performed monthly for at least 6 months for 14 of the men. Information was obtained by interview and extracted from medical records to identify clinical variables associated with HIV-1 in semen.

Patients.
—Sixty HIV-1 seropositive homosexual men participating in clinical studies at the Fenway Community Health Center, Boston, Mass, and 35 HIV seropositive bisexual or heterosexual men participating in the California Partner Study of the University of California, San Francisco.

Main Outcome Measures.
—Semen HIV-1 culture results, seminal leukocyte counts, Centers for Disease Control (CDC) disease stage, peripheral CD4⁺ cell counts, zidovudine therapy, HIV risk category.

Results.
—In the cross-sectional study, HIV-1 was cultured from the semen of nine (9%) of 95 men. Factors associated with detection of HIV-1 in semen were peripheral CD4⁺ cell counts of 0.20x 10⁹/L (200/µL) or less (adjusted odds ratio [OR], 23.33; 95% confidence interval [CI], 2.89 to 175.63); symptomatic (CDC class IV) disease (adjusted OR, 6.56; 95% CI, 1.02 to 66.76); and seminal leukocytosis (>1 x10⁹ white blood cells per liter of semen) (adjusted OR, 7.02; 95% CI, 1.28 to 39.29). Zidovudine therapy was associated with decreased detection of HIV-1 in semen (adjusted OR, 0.04; 95% CI, 0.00 to 0.63). In the longitudinal study of 14 men who had neither peripheral CD4⁺ cells counts of 0.20 x 10⁹/L or less nor seminal leukocytosis, seminal HIV-1 was detected in at least one sample from six men (43%).

Conclusion.
—HIV-1 is more commonly found in semen from men with advanced HIV-1 infection and seminal leukocytosis but can also be cultured from semen of men with neither of these conditions. Zidovudine therapy may decrease the prevalence and/or titer of seminal HIV-1. However, all HIV-1—infected persons should continue to assume that they are potentially infectious through sexual contact.

(JAMA. 1992;267:2769-2774)

Author Affiliations
From the Fearing Research Laboratory, Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Mass (Drs Anderson and Politch and Ms Martinez); the Division of HIV/AIDS, Center for Infectious Diseases/Centers for Disease Control, Atlanta, Ga (Drs O'Brien and Horsburgh); the Institute for Urban Health Research, Boston Department of Health and Hospitals, and the Department of Epidemiology and Biostatistics, Boston University School of Public Health (Dr Seage); the Department of Epidemiology and Biostatistics, University of California San Francisco (Dr Padian); and the Infectious Disease Branch, Memorial Hospital, Pawtucket, RI, and the Fenway Community Health Center, Boston, Mass (Dr Mayer).

Footnotes
Presented in part at the VI International Conference on AIDS; June 21, 1990; San Francisco, Calif.

The views expressed by the authors do not necessarily reflect the views of the CONRAD Program.

Reprint requests to Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Room 204, 250 Longwood Ave, Boston MA 02115 (Dr Anderson).

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