Important note: Information in this article was accurate in December 1999. The state of the art may have changed since the publication date.
In a study presented at the 39th ICAAC by P.F. Barroso, MD, and colleagues from Johns Hopkins University in Baltimore, people with genital warts had a significantly higher semen viral load than those without genital warts. One hundred and three HIV positive participants had blood plasma and semen samples tested for HIV RNA viral load using the Nuclisens assay. Median CD4 cell count was 269 cells/mm³, median blood viral load was 42,000 copies/mL, and median semen viral load was 6,400 copies/mL. Eighteen (17%) of the men had genital warts-and a higher semen viral load-at the time of evaluation. In a multiple linear statistical analysis, the only significant factors associated with semen viral load were blood viral load and the presence of genital warts. Several other sexually transmitted diseases (STDs) have also been shown to raise the amount of HIV in genital fluids, which increases the risk of sexual transmission.
Genital warts are caused by the human papillomavirus (HPV). They are very common in the general population and among those with HIV infection. The warts may be quite small, even the size of a pinhead.
Lead authors L.V. Torian, MD, and M.G. Beumont, MD, presented these two studies at the 39th ICAAC. In New York men, the finding was associated with HIV infection. Rectal gonorrhea is a marker for unsafe (i.e., without a condom) receptive anal intercourse. Like many other STDs, gonorrhea increases the risk of receiving or transmitting HIV. Higher incidence of unsafe sexual behavior could foreshadow an increase in the rate of HIV transmission. In addition, newly transmitted strains are more likely to display resistance to currently available anti-HIV drugs.
This study was presented at the 39th ICAAC by S. Taylor, MD, from the University of Birmingham, England. The level of nevirapine in semen plasma (liquid portion without sperm or cells) was 60% of that in blood plasma. This level is still approximately 40-fold higher than the concentration needed to inhibit 90% of HIV strains (IC90) in the test tube. The concentration of anti-HIV drugs in genital fluids is an important issue for preventing transmission to sexual partners if safer sexual practices are not employed.
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