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Observational Study
. 2023 Nov 15;37(14):2233-2238.
doi: 10.1097/QAD.0000000000003679. Epub 2023 Aug 2.

HIV and urethritis: time required for antiretroviral therapy to suppress HIV in semen

Mitch Matoga  1 , Jane S Chen  2 , Cecilia Massa  1 , Isaac Thengolose  1 , Gerald Tegha  1 , Beatrice Ndalama  1 , Naomi Bonongwe  1 , Esther Mathiya  1 , Edward Jere  1 , Gabriel Banda  1 , Shiraz Khan  1 , Amy J Loftis  2 , Angela Kashuba  3 , Mackenzie L Cottrell  3 , Amanda P Schauer  3 , Brian Van Horne  3 , Lauren A Tompkins  3 , Kathryn E Lancaster  4 , William C Miller  4 , Joseph J Eron  2 , Irving F Hoffman  2 , Myron S Cohen  2
Affiliations
Observational Study

HIV and urethritis: time required for antiretroviral therapy to suppress HIV in semen

Mitch Matoga et al. AIDS. .

Abstract

Objectives: To examine the time required to suppress HIV in the genital tract with antiretroviral therapy (ART) in men with urethritis.

Design: An observational cohort study.

Methods: Men with HIV and urethritis not on ART were enrolled at an STI clinic in Malawi and offered to initiate ART. Blood and semen samples were collected pretreatment and at 1, 2, 4, 8, 12 and 24 weeks posturethritis treatment. Median viral loads (VLs) were calculated by ART initiation groups: 'within 1 week', 'between 1 and 4 weeks' and 'no ART before 4 weeks', based on the men's choice about whether or not to initiate ART. The presence of ART at each visit was confirmed by bioanalytical methods.

Findings: Between January 2017 and November 2018, 74 men presented with urethritis and HIV and were confirmed ART naive. The median age was 32 years. Forty-one (55% of men) initiated ART within 1 week; 12 (16%) between 1 and 4 weeks; and 21 (28%) did not initiate ART by week 4. Within the 1 week group, median VL was suppressed within 4 weeks in both semen and blood. Among the 1-4 weeks group, VL was suppressed within 4 weeks in semen and 5 weeks in blood. Among the no ART before 4 weeks group, VL in semen declined within the first 4 weeks but remained unsuppressed through week 24, and there was no significant decline in blood HIV.

Conclusion: Treatment of urethritis and prompt initiation of ART with counseling for safer sex for at least one month is a critical measure to reduce transmission of HIV.

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Conflict of interest statement

This work was supported by the National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health [R01 DK108424 to M.S.C.]; the National Institute of Allergy and Infectious Diseases at the National Institutes of Health [R01 AI114320 to W.C.M.; T32 AI070114 to J.S.C.]; and the Fogarty International Center at the National Institutes of Health [D43 TW010060 to M.M.]. The STI Clinic at Bwaila District Hospital is co-funded by the Lilongwe District Health Office, the Malawi Ministry of Health, and UNC Project, Malawi. A.K., M.L.C., A.P.S., B.V.H. and L.A.T. were supported by the University of North Carolina at Chapel Hill Center for AIDS Research (CFAR) Clinical Pharmacology/Analytical Chemistry Core, an NIH funded program P30AI050410. M.S.C. acts in an advisory role for Astra Zeneca, Gilead, Aerium and OPKO. The remaining authors declare no other conflicts of interest.

Figures

Fig. 1
Fig. 1
Median viral load in blood and semen by visit across ART initiation groups.
See this image and copyright information in PMC

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