Potential for the Transmission of HIV-1 Despite Highly Active Antiretroviral Therapy

Important note: Information in this article was accurate in 1998. The state of the art may have changed since the publication date.

Potential for the Transmission of HIV-1 Despite Highly Active Antiretroviral Therapy

New England Journal of Medicine (12/17/98) Vol. 339, No. 25, P. 1846
Haase, Ashley T.; Schacker, Timothy W.

In an editorial appearing in the New England Journal of Medicine, Drs. Ashley T. Haase and Timothy W. Schacker of the University of Minnesota comment on recent findings by Zhang et al. that men receiving highly active antiretroviral therapy and who have undetectable levels of HIV RNA may be able to transmit the virus through sexual contact. Zhang and colleagues detected replication-competent proviruses in the seminal cells of two men. They hypothesize that viral replication might continue in the male genital tract because the blood-testes endothelial barrier may prevent the entry of antiretroviral drugs in high concentrations. They also found that the recovered viruses in seminal cells were still sensitive to antiretroviral drugs and that sequences differed between the recovered viruses found in the peripheral blood and those found in seminal cells. This suggests that latently infected cells from an earlier stage of HIV-1 infection entered and remained in the male genital tract. Haase and Schacker state that while the genital secretions from these patients are not likely to transmit infection since the degree of infectiousness is correlated with the stage of HIV-1 and the levels of the virus and infected cells in the genital tract, efforts to foster preventive behavior should still be pursued. They assert that sexually transmitted diseases could increase the reactivation of latently infected cells in donor semen and could, therefore, increase incidence. The authors conclude that "it is clearly time not only to renew efforts to prevent sexually transmitted diseases, and to treat them when present, but also, more fundamentally, to increase our commitment to sustain the behavioral and social changes that are the surest guarantee against HIV-1 infection."

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