HIV This Week

Butler DM, Smith DM, Cachay ER, Hightower GK, Nugent CT, Richman DD, Little SJ. Herpes simplex virus 2 serostatus and viral loads of HIV- 1 in blood and semen as risk factors for HIV transmission among men who have sex with men. AIDS. 2008;22(13):1667-71.

Human immunodeficiency virus type 1 blood plasma viral load is correlated with the sexual transmission of HIV, although transmission from men involves virus from semen instead of blood. Butler and colleagues quantified HIV-1 RNA in the blood and semen of men who did or did not transmit HIV to their sex partners. They compared the relationships of HIV-1 transmission risk with blood plasma viral load, seminal plasma viral load, herpes simplex virus 2 serostatus and other factors. In this case-control study, participants were men evaluated for primary HIV infection and their recent male sex partners. They were interviewed, and clinical specimens were collected. Epidemiologic and phylogenetic linkages were determined by history and molecular techniques. Couples were grouped on the basis of transmission after exposure. Fisher’s exact test and Wilcoxon tests were used for comparisons between groups. Multivariable logistic regressions were fit to identify independent predictors of transmission. HIV-transmitting partners (n = 15) had a higher median seminal plasma viral load (P < 0.015) and median blood plasma viral load (P < 0.001) than nontransmitting partners (n = 32). Herpes simplex virus 2 serostatus was associated with transmission only when the HIV-infected source partner was herpes simplex virus 2 seropositive and the HIV-exposed partner was not (odds ratio 16, P < 0.03). Adjusting for other factors, HIV transmission was significantly associated with blood plasma viral load (odds ratio 13.4, P < 0.02) but not seminal plasma viral load (odds ratio 0.69, P = not significant). The authors conclude that blood and seminal plasma viral load were both associated with human immunodeficiency virus type 1 transmission, but blood plasma viral load was the stronger predictor in this cohort. Herpes simplex virus 2 coinfection was associated with the risk of transmission but not acquisition of human immunodeficiency virus type 1 .

Editors’ note: Fifteen ‘transmitting’ pairs and 32 ‘non-transmitting’ pairs were compared in this study of men who have sex with men. Herpes simplex virus-2 infection was associated with transmission when the source person was co-infected but made no difference if the non-HIV-infected man was HSV-2 sero-positive. This is consistent with the negative findings from trials of herpes suppression to reduce HIV acquisition and support continuation of the trials assessing herpes suppression in co-infected people to reduce HIV transmission. The jury is still out on whether it is cell-free virus in semen (measured in seminal plasma viral load) or cell-associated virus (not measured) that increases risk of HIV transmission – in this study cell-free virus levels were associated with transmission.