Effects of disease stage and zidovudine therapy on the detection of human immunodeficiency virus type 1 in semen
D. J. Anderson, T. R. O'Brien, J. A. Politch, A. Martinez, G. R. Seage 3rd, N. Padian, C. R. Horsburgh Jr and K. H. Mayer
Fearing Research Laboratory, Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA 02115.
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 0.20 x 10(9)/L (200/microL) or less (adjusted odds
ratio [OR], 23.33; 95% confidence interval [Cl], 2.89 to 175.63);
symptomatic (CDC class IV) disease (adjusted OR, 6.56; 95% Cl, 1.02 to
66.76); and seminal leukocytosis (greater than 1 x 10(9) white blood cells
per liter of semen) (adjusted OR, 7.02; 95% Cl, 1.28 to 39.29). Zidovudine
therapy was associated with decreased detection of HIV-1 in semen (adjusted
OR, 0.04; 95% Cl, 0.00 to 0.63). In the longitudinal study of 14 men who
had neither peripheral CD4+ cells counts of 0.20 x 10(9)/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.
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