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Author Notes:

Correspondence: Colleen F. Kelley, MD, MPH, Grady Ponce de Leon Center, 341 Ponce de Leon Ave, Atlanta, GA 30308 (colleen.kelley@emory.edu).

Potential conflicts of interest: none reported.

Presented in part: 17th Conference on Retroviruses and Opportunistic Infections, San Francisco, CA, 6–19 February 2010. Abstract 486.

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Research Funding:

This work was supported by Centers for Disease Control and Prevention contracts 200–2002-00610/00611/00612/00613 and 200–2007-3633/23634/23635/23636. This work was supported in part by the National Institutes of Health (KL2 RR025009 to C. F. K) and a Bristol Myers Squibb Virology Fellowship award to C. F. K.

HIV-1 RNA Rectal Shedding Is Reduced in Men With Low Plasma HIV-1 RNA Viral Loads and Is Not Enhanced by Sexually Transmitted Bacterial Infections of the Rectum

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Journal Title:

Journal of Infectious Diseases

Volume:

Volume 204, Number 5

Publisher:

, Pages 761-767

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Background. Among human immunodeficiency virus (HIV)–infected men who have sex with men (MSM) taking combination antiretroviral therapy (cART), the impact of rectal sexually transmitted infections (STIs) on rectal HIV-1 shedding is unknown. Methods. Human immunodeficiency virus type 1 (HIV-1) RNA was quantified from rectal swabs collected for Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) screening of HIV-1-infected MSM. Correlations of STIs with rectal viral load were explored using multinomial regression modeling. HIV-1 coreceptor tropism was predicted from sequencing in a subset of men. Results. Thirty-one (39%) of 80 men (59 prescribed combination antiretroviral therapy [cART]) had HIV detected in 38 (42%) of 91 rectal swabs. Rectal HIV detection was associated with plasma virus loads above 3.15 log10 copies/mL (95% confidence limit [CL] 2.73, 3.55) and paired rectal viral loads and plasma viral loads were correlated (Kendall’s tau [τ] 0.68, Spearman rho [P] = .77). Rectal STIs and abnormal anal cytology were not associated with rectal viral load. HIV coreceptor distribution was very similar between the plasma and rectum in 3 of 4 men. Conclusions. Plasma and rectal viral load were correlated, and rectal STIs did not increase the likelihood of detecting HIV in the rectal secretions in MSM, including those with low or undetectable plasma viral load. Suppressing plasma viral load is likely to reduce risk of HIV transmission to insertive partners.

Copyright information:

Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2011.

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