Risk factors for HIV-1 shedding in semen

Carl E. Speck, Robert W. Coombs, Laura A. Koutsky, Judith Zeh, Susan O. Ross, Thomas M. Hooton, Ann C. Collier, Lawrence Corey, Anne Cent, Joan Dragavon, Willa Lee, Eric J. Johnson, Reigran R. Sampoleo, John N. Krieger

Research output: Contribution to journalArticlepeer-review

46 Scopus citations


Semen is the body fluid most commonly associated with sexual transmission of human immunodeficiency virus type-1 (HIV-1). Because the male genitourinary tract is distinct immunologically from blood, compartment- dependent factors may determine HIV-1 shedding in semen. To identify these factors, the authors obtained 411 semen and blood specimens from 149 men seen up to three times. Seminal plasma was assayed for HIV-1 RNA and semen was cocultured for HIV-1 and cytomegalovirus (CMV), which may up-regulate HIV-1 replication. The best multivariate model for predicting a positive semen HIV- 1 coculture included two local urogenital factors, increased seminal polymorphonuclear cell count (odds ratio (OR) = 12.6 for each log10 increase/mL, 95% confidence interval (Cl) 12.2, 134.5) and a positive CMV coculture (OR = 3.0, 95% Cl 1.2, 7.7). The best multivariate model for predicting semen HIV-1 RNA included two systemic host factors, CD4+ cell counts <200/μliter (OR = 3.0, 95 percent Cl 1.3, 6.9) and nucleoside antiretroviral therapy (monotherapy: OR = 0.5, 95% Cl 0.3, 1.0; combination therapy: OR = 0.4, 95% Cl 0.2, 0.9), and a positive CMV coculture (OR = 1.7, 95% Cl 1.0, 3.0). Thus, both systemic and local genitourinary tract factors influence the risk of semen HIV-1 shedding. These findings suggest that measures of systemic virus burden alone may not predict semen infectivity reliably.

Original languageEnglish (US)
Pages (from-to)622-631
Number of pages10
JournalAmerican journal of epidemiology
Issue number6
StatePublished - Sep 15 1999
Externally publishedYes


  • Acquired immunodeficiency syndrome
  • Coculture
  • Cytomegalovirus
  • HIV- 1
  • Polymerase chain reaction
  • RNA, viral
  • Semen

ASJC Scopus subject areas

  • Epidemiology


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