Effects of disease stage and zidovudine therapy on the detection of human immunodeficiency virus type 1 in semen

Objective. —To determine the prevalence and temporal expression of infectious human immunodeficiency virus type 1 (HIV-1) in the semen of HIV-1 seropositive men and to determine whether the detection of HIV-1 in semen is associated with disease stage, zidovudine treatment status, or other clinical factors. Design. —A microculture technique was used to detect infectious HIV-1 in semen from a cohort of 95 seropositive men. In addition, semen cultures were performed monthly for at least 6 months for 14 of the men. Information was obtained by interview and extracted from medical records to identify clinical variables associated with HIV-1 in semen. Patients. —Sixty HIV-1 seropositive homosexual men participating in clinical studies at the Fenway Community Health Center, Boston, Mass, and 35 HIV seropositive bisexual or heterosexual men participating in the California Partner Study of the University of California, San Francisco. Main Outcome Measures. —Semen HIV-1 culture results, seminal leukocyte counts, Centers for Disease Control (CDC) disease stage, peripheral CD4+cell counts, zidovudine therapy, HIV risk category. Results. —In the cross-sectional study, HIV-1 was cultured from the semen of nine (9%) of 95 men. Factors associated with detection of HIV-1 in semen were peripheral CD4+cell counts of 0.20× 109/L (200/μL) or less (adjusted odds ratio OR, 23.33; 95% confidence interval CI, 2.89 to 175.63); symptomatic (CDC class IV) disease (adjusted OR, 6.56; 95% CI, 1.02 to 66.76); and seminal leukocytosis (>1 ×109white blood cells per liter of semen) (adjusted OR, 7.02; 95% CI, 1.28 to 39.29). Zidovudine therapy was associated with decreased detection of HIV-1 in semen (adjusted OR, 0.04; 95% CI, 0.00 to 0.63). In the longitudinal study of 14 men who had neither peripheral CD4+cells counts of 0.20 × 109/L or less nor seminal leukocytosis, seminal HIV-1 was detected in at least one sample from six men (43%). Conclusion. —HIV-1 is more commonly found in semen from men with advanced HIV-1 infection and seminal leukocytosis but can also be cultured from semen of men with neither of these conditions. Zidovudine therapy may decrease the prevalence and/or titer of seminal HIV-1. However, all HIV-1—infected persons should continue to assume that they are potentially infectious through sexual contact. (JAMA. 1992;267:2769-2774)