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In HIV Infection, "Undetectable" Is Still Infectious
Although combination antiretroviral therapy can ablate HIV RNA from the plasma of infected persons, studies have shown that infectious virus still persists within their cells. This study extends the observation to cells in the semen of HIV-infected men.
Seven HIV-infected men successfully treated with combination antiretroviral therapy for 5 to 41 months donated semen samples for analysis. All had undetectable plasma and seminal HIV RNA levels (less than 50 copies/ml). However, cell-associated HIV DNA was detected in peripheral blood mononuclear cells of all seven men and in the seminal cells of four; virus was cultured from the blood of three men and the semen of two. Both isolates cultured from semen had tropisms characteristic of sexually transmissible strains of HIV. Neither strain had mutations conferring resistance to the antiretroviral drugs the patients were taking, lending support to the theory that genital-tract cells may be a site where replication-competent HIV is effectively sequestered for years after primary infection.
Comment: When HIV-infected patients are told that their blood viral loads are "undetectable," they often surmise, understandably enough, that they are no longer infectious. Physicians must be aware of this misapprehension and remember to address it often. An editorialist comments that while patients doing well on therapy may not be as infectious as others, they are still definitely capable of transmitting their disease.
— A Zuger
Published in Journal Watch General Medicine December 22, 1998
Citation(s):
Zhang H et al. Human immunodeficiency virus type I in the semen of men receiving highly active antiretroviral therapy. N Engl J Med 1998 Dec 17 339 1803-1809.
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Haase AT and Schacker TW. Potential for the transmission of HIV-1 despite highly active antiretroviral therapy. N Engl J Med 1998 Dec 17 339 1846-1847.
- Original article (Subscription may be required)
- Medline abstract (Free)