Barcelona 2013
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| Abstract #259 - Drugs and Alcohol | ||||
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Session: 22.1: Drugs and Alcohol (Parallel) on Monday @ 16.30-18.30 in Mirador Chaired by Sam Friedman, Rosa Mansilla Authors: Presenting Author: Dr SUZAN-MONTI Marie - INSERM U912, France |
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| Additional Authors: Dr. Patricia Solomon, Mr. Larry Baxter, Dr. Alan Casey, Mr. Will Chegwidden, Mr. Duncan MacLachlan, Dr. Joy MacDermid, Ms. Anne-Marie Tynan, Dr. Greg Robinson, Dr. Barry Trentham, Ms. Janet Wu, Ms. Elisse Zack, | ||||
| Aim: Some HIV-infected men may harbor HIV-RNA in semen despite an optimal control of viral replication in blood plasma and thus be at risk of HIV transmission in case of unprotected sexual intercourse. Only one cross-sectional study addressed this issue among seropositive Men who have Sex with Men (MSM), one of the most at-risk population for HIV transmission. The rate of discordance between undetectable blood plasma viral load (bpVL) and detectable semen plasma VL (spVL) among MSM might be higher than among the general population due to the existence of biological and behavioral factors that could lead to HIV local replication. The objective of the present study was to characterize the behavioral components, such as drug use, that might influence and explain HIV shedding in semen despite an undectable bpVL. | ||||
| Method / Issue: HIV-1 infected MSM on stable successful combined antiretroviral treatment (cART), i.e. blood plasma HIV-RNA < 50 copies/ml for at least 6 months with no clinical sign of sexually transmitted infections, were enrolled (n= 157) in 6 HIV hospitals in Paris and nearby suburbs. Seminal and blood plasma HIV-RNA were quantified from two paired samples collected one month apart using ultrasensitive assay. Socio-behavioral data were collected through self-administered questionnaires at enrolment and M1. Statistical analysis was made using a GEE logistic regression accounting for repeated sampling in the same individual. The variable ?Cannabis use? was assessed using the question ?During the last 3 months, were you under the influence of cannabis during sexual relationships with your steady or regular/casual partners?? (sometimes/often versus rarely/never). | ||||
| Results / Comments: Median (IQR) age of MSM enrolled in the study was 44 years (27-67); 78.3% of them were high-school graduate or above and 80% were in active employment. Ninety seven patients (61.8%) had a steady partner and 61 of them (62.9%) had regular and/or casual partners during the previous 3 months. The median number of these partners was 2 (range 2-4) and 6 (range 3-12), respectively. Patients? main characteristics were as follows: median current CD4 cell count: 637/mm3 (152-1721); median time on stable cART: 2.1 years (0.3-12.4); median time with bpVL < 50 cp/ml: 3.3 years (0.5-13.7) and median PBMC-HIV-1 DNA (copies/106 PBMC): 229 (70-2099). SpVL was detectable in 23/304 semen samples with a median of 145 cp/ml (50-1475) yielding a prevalence of 7.6%. Among MSM with detectable spVL, 22.7% reported cannabis use during sexual intercourses compared to 7.3% in MSM with undetectable spVL. After multivariable adjustments, cannabis use was the only behavioral factor significantly associated with HIV shedding in semen (OR[95%CI] 2.9 [1.2 ; 7.0], p=0.02), after adjustment on PBMC-HIV-1 DNA that was also significant (OR[95%CI] 2.5 [1.1 ; 5.8], p=0.03). | ||||
| Discussion: HIV-positive people may use cannabis either for therapeutic or recreational purposes. Cannabis is already known to have modulatory effects on immune function and adverse effects on male fertility. The present results indicate that the possible effect of cannabis on HIV seminal shedding should be taken into account when developing prevention interventions to reduce sexual risk behaviour in HIV-infected MSM on successful cART. | ||||
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