The risk of sexual transmission is conditioned by the presence of HIV-1 infected cells and viral particles in genital secretions. Infected cells in semen represent an increased risk of HIV-1 cell to cell transmission Primary HIV Infection (PHI) is brief but very efficient in terms of viral transmission. We studied the impact of early-cART in PHI and the influence of the systemic activation on HIV-semen and blood reservoir dynamic.
Patients from the ANRS-147-OPTIPRIM randomized trial received two years of early-cART. Blood and seminal samples were collected at inclusion and month 24. Total cell-associated-HIV-DNA and HIV-RNA were quantified in blood, semen cells and seminal plasma (Biocentric, Bandol, France). Interferon-y-inducible interferon 10 (IP-10) and interleukin-6 (IL6) were quantified by ELISA in blood plasma. Spearman correlation tests were performed.
Twenty-one patients participated to this substudy (median age: 36 years, time from estimated date of infection: 33 days), 20 were symptomatic and 8 presented acute infection (WB ≤1 Ab). At enrolment, median HIV-RNA was significantly higher in blood (5.39 log10cp/mL) than in semen (4.22) (p< 0.0001). Median blood and seminal HIV-DNA level was 3.59 and 0.31 log10cp/106PBMC, respectively. Semen HIV-RNA was correlated with CD4 count (r=-0.54, p=0.018) and CD8 count (r=-0.54 p=0.018). Furthermore, IP-10 positively correlated with blood HIV-RNA (r=0.46 p=0.046), blood and semen HIV-DNA (r=0.53 p=0.018; r=0.51 p=0.026), IL-6 (r=0.68 p=0.003) and negatively with CD4/CD8 ratio (r=-0.59 p=0.006) (Figure1). Among the 8 patients with acute infection, semen-HIV-RNA correlated with blood-HIV-RNA (r=0.81, p=0.015), CD4 count (r=-0.98, p<0.0001), CD4/CD8 ratio (r=-0.85, p=0.0075). Two years effective cART induced an important and significant decrease in blood and semen HIV-RNA levels
This is the first evidence of HIV-reservoir cells in semen of patients with PHI, showing that levels are linked with the immunosuppression severity and plasma IP-10 level. Early treatment allows purging viral particles and also infected cells, which reduces the high risk of HIV transmission during PHI.