We describe the antiviral effect of maraviroc in a patient who had been shedding high levels of HIV-1 in seminal fluid for three years despite an undetectable blood plasma viral load. Adding maraviroc to HAART stopped the seminal shedding. We discuss the mechanisms involved and the effect on sexual transmission.
References
1.
ThompsonM.A., AbergJ.A., CahnP.Antiretroviral treatment of adult HIV infection: 2010 recommendations of the International AIDS Society–USA panel. JAMA2010; 304: 321–333.
2.
MarcelinA.G., TubianaR., Lambert-NiclotS.Detection of HIV-1 RNA in seminal plasma samples from treated patients with undetectable HIV-1 RNA in blood plasma. AIDS2008; 22: 1677–1679.
3.
HalfonP., GiorgettiC., KhiriH.Semen may harbor HIV despite effective HAART: another piece in the puzzle. PLoS ONE2010; 5: e10569.
4.
ShethP.M., KovacsC., KemalK.S.Persistent HIV RNA shedding in semen despite effective antiretroviral therapy. AIDS2009; 23: 2050–2054.
5.
BujanL., HollanderL., CoudertM.Safety and efficacy of sperm washing in HIV-1-serodiscordant couples where the male is infected: results from the European CREAThE network. AIDS2007; 21: 1909–1914.
6.
PasquierC., SauneK., RaymondS.Determining seminal plasma human immunodeficiency virus type 1 load in the context of efficient highly active antiretroviral therapy. J Clin Microbiol2009; 47: 2883–2887.
7.
RaymondS., DelobelP., MavignerM.Development and performance of a new recombinant virus phenotypic entry assay to determine HIV-1 coreceptor usage. J Clin Virol2010; 47: 126–130.
8.
TachetA., DulioustE., SalmonD.Detection and quantification of HIV-1 in semen: identification of a subpopulation of men at high potential risk of viral sexual transmission. AIDS1999; 13: 823–831.
9.
PasquierC.J., MoinardN., SauneK.Persistent differences in the antiviral effects of highly active antiretroviral therapy in the blood and male genital tract. AIDS2008; 22: 1894–1896.
10.
PereiraA.S., KashubaA.D., FiscusS.A.Nucleoside analogues achieve high concentrations in seminal plasma: relationship between drug concentration and virus burden. J Infect Dis1999; 180: 2039–2043.
11.
BrownK.C., PattersonK.B., MaloneS.A.Single and multiple dose pharmacokinetics of maraviroc in saliva, semen, and rectal tissue of healthy HIV-negative men. J Infect Dis2011; 203: 1484–1490.
12.
KashubaA.D., DyerJ.R., KramerL.M., RaaschR.H., EronJ.J., CohenM.S.Antiretroviral-drug concentrations in semen: implications for sexual transmission of human immunodeficiency virus type 1. Antimicrob Agents Chemother1999; 43: 1817–1826.
13.
BarauC., DelaugerreC., BraunJ.High concentration of raltegravir in semen of HIV-infected men: results from a substudy of the EASIER-ANRS 138 trial. Antimicrob Agents Chemother2010; 54: 937–939.
14.
DumondJ.B., ReddyY.S., TroianiL.Differential extracellular and intracellular concentrations of zidovudine and lamivudine in semen and plasma of HIV-1-infected men. J Acquir Immune Defic Syndr2008; 48: 156–162.
15.
AndersonJ.A., PingL.H., DibbenO.HIV-1 populations in semen arise through multiple mechanisms. PLoS Pathog2010; 6: e1001053.
16.
PolitchJ.A., MayerK.H., AndersonD.J.Depletion of CD4+ T cells in semen during HIV infection and their restoration following antiretroviral therapy. J Acquir Immune Defic Syndr2009; 50: 283–289.
17.
HasseB., LedergerberB., HirschelB.Frequency and determinants of unprotected sex among HIV-infected persons: the Swiss HIV cohort study. Clin Infect Dis2010; 51: 1314–1322.