Rapid HIV Rebound in Semen After Antiretroviral Treatment Interruption

A new study suggests that combined antiretroviral treatment in patients with HIV does not prevent viral load rebound in semen after the treatment is paused.

Combined antiretroviral treatment (cART) in patients with HIV does not prevent viral load rebound in semen after the treatment is paused, according to the results of a new study published online on October 15 in the journal AIDS.

“Overall, the rapid and intense HIV-RNA rebound observed very early, both in blood and semen, after ATI [antiretroviral treatment interruption] emphasizes the need for targeted prevention strategies to reduce the risk of sexual transmission during all the trials involving treatment interruptions,” co-lead authors Dr. Romain Palich, MD, and Constance Delaugerre, MD, PhD, both from Université Paris Diderot, France, and colleagues, write.

Recent studies have shown that short pauses in antiretroviral treatment in patients with HIV do not result in a long-term increase in the size of the HIV reservoir or cause irreversible damage to the immune system. However, the effect of this treatment pause on HIV replication in the genital tract remains unknown.

With this in mind, the investigators aimed to compare the timing of HIV rebound and its level in blood and seminal plasma after patients discontinued antiretroviral treatment. They also sought to characterize the rebound HIV populations.

They performed a substudy in HIV-1-infected men who were enrolled in the VRI02/ANRS149-LIGHT therapeutic vaccine trial. Ten men discontinued antiretroviral treatment for 12 weeks, providing paired blood and semen samples both before (week 32 or 36) and during (week 38, 40, 42, 44, and 48) the treatment pause.

The investigators found that HIV-RNA rebounded in blood plasma and seminal plasma of all 10 men after ATI. The virus rebounded in blood plasma as early as week 38 in 8 men, and in seminal plasma between weeks 38 and 40 in 8 men.

“This finding supports evidence of a very high risk of sexual transmission during self-driven cART breaks or during ATI stemming from clinical trials,” the authors emphasize. “Thus, prevention strategies for HIV-negative partners of HIV-infected participants undergoing ATI need reinforcement.”

Additional findings also indicated the mixing of the HIV-RNA populations from plasma and semen, suggesting a lack of viral segregation between the two compartments.

“Intermingled rebounding HIV sequences between blood and semen suggest that future therapeutic vaccines or HIV cure strategies should be a useful tool to reduce cART prolonged exposure while allowing for a sustained reduction in the risk of sexual transmission,” the authors conclude.

Dr. Parry, a board-certified veterinary pathologist, graduated from the University of Liverpool in 1997. After 13 years in academia, she founded Midwest Veterinary Pathology, LLC, where she now works as a private consultant. Dr. Parry writes regularly for veterinary organizations and publications.