Journal Article

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

Kenneth H. Mayer, Stephen Boswell, Robert Goldstein, Wilson Lo, Chong Xu, Lynne Tucke Tucker, Maria Pia DePasquale, Richard D'Aquila and Deborah J. Anderson

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 28, issue 6, pages 1252-1259
Published in print June 1999 | ISSN: 1058-4838
Published online June 1999 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/514775
Persistence of Human Immunodeficiency Virus in Semen After Adding Indinavir to Combination Antiretroviral Therapy

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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.

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Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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