Detectable HIV-1 in semen in individuals with very low blood viral loads

Kariuki, Samuel Mundia ; Selhorst, Philippe ; Norman, Jennifer ; Cohen, Karen ; Rebe, Kevin ; Williamson, Carolyn ; Dorfman, Jeffrey R (2020-03-05)

CITATION: Kariuki, S. M., et al. 2020. Detectable HIV-1 in semen in individuals with very low blood viral loads. Virology Journal, 17:29, doi:10.1186/s12985-020-01300-6.

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Background: Several reports indicate that a portion (5–10%) of men living with HIV-1 intermittently shed HIV-1 RNA into seminal plasma while on long term effective antiretroviral therapy (ART). This is highly suggestive of an HIV-1 reservoir in the male genital tract. However, the status of this reservoir in men living with HIV-1 who are not under treatment is underexplored and has implications for understanding the origins and evolution of the reservoir. Finding: Forty-three HIV-1 positive, antiretroviral therapy naïve study participants attending a men’s health clinic were studied. Semen viral loads and blood viral loads were generally correlated, with semen viral loads generally detected in individuals with blood viral loads > 10,000 cp/ml. However, we found 1 individual with undetectable viral loads (<20cp/ml) and 2 individuals with very low blood viral load (97 and 333cp/ml), but with detectable HIV-1 in semen (485–1157 copies/ semen sample). Blood viral loads in the first individual were undetectable when tested three times over the prior 5 years. Conclusions: Semen HIV-1 viral loads are usually related to blood viral loads, as we confirm. Nonetheless, this was not true in a substantial minority of individuals suggesting unexpectedly high levels of replication in the male genital tract in a few individuals, despite otherwise effective immune control. This may reflect establishment of a local reservoir of HIV-1 populations.

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