Context:Long-term adherence to antiretrovirals is critical for sustained virologic response to HIV therapy in blood. Although antiretroviral therapy (ART) reduces HIV seminal shedding, little is known about the relationship between adherence to ART and HIV suppression in semen.
Objective:To determine predictors of seminal HIV RNA suppression after 6 months of ART.
Design:Prospective observational cohort of 93 HIV-infected subjects before and after introduction of ART. Seminal HIV RNA was measured at baseline and 1, 2, 3, and 6 months after the introduction of therapy. Adherence to therapy was measured by self-report.
Setting:A large academic HIV reference center in Rio de Janeiro, Brazil.
Main Outcome Measure:Detectable HIV RNA in semen.
Results:In a multivariate logistic model with undetectable seminal HIV RNA after 6 months of therapy as the outcome variable, adjusting for baseline seminal viral load, both being adherent to therapy (OR = 11.8, P < 0.01) and using triple-drug ART (OR = 6.48, P = 0.04) were independently associated with seminal HIV RNA suppression.
Conclusions:Inability to adhere to therapy was strongly associated with persistent shedding of HIV RNA in semen. Measures to improve adherence are urgently needed to reduce the sexual spread of potentially drug-resistant HIV among subjects using antiretrovirals.
Support for this study was provided in part by a Research Career Award, National Institute of Allergy and Infectious Diseases (K24 AI52788) to Lee H. Harrison and by grants from the Fogarty International Center, National Institutes of Health (3 D43 TW01038 [University of Pittsburgh] and 5D43 TW0010 [Johns Hopkins University]) and the National Program of AIDS/STDs of the Brazilian Ministry of Health (TC 271/97) and by a grant from the Conselho Nacional de Desenvolvimento Cientifico e Technológico (CNPq) to Dr. Mauro Schechter.
Address correspondence and reprint requests to Paulo Feijó Barroso, Rua Almirante Alexandrino 3780/E3/302, Rio de Janeiro, Brazil 20241-262; e-mail: firstname.lastname@example.org
Manuscript received June 3, 2002: accepted November 13. 2002.
© 2003 Lippincott Williams & Wilkins, Inc.