芭芭拉‧榮格沃斯 /  202401/09  / TheBodyPro

根據秘魯進行的一項小型研究的結果，在診斷出愛滋病毒後立即開始抗反轉錄病毒治療不僅有助於保護一個人的健康，而且還可以迅速將精液病毒載量降低到病毒不可能傳播的水平。

關於本研究

「在早期 HIV-1 感染期間啟動 ART 時血漿和精液中的病毒載量動態」作為簡短報告，於 2023 年 11 月 24 日在線上發表在《傳染病雜誌》上。 主要作者是印度孟買 Unison 醫療保險與研究中心的 Trupti Gilada（醫學博士、M.B.B.S.）和位於明尼阿波利斯的明尼蘇達大學之傳染病研究與政策中心和環境健康科學部門的Angela K. Ulrich（博士、公共衛生碩士）。 研究藥物分別由其製造商吉利德科學公司和默沙東公司捐贈。

主要研究成果

研究人員評估了2013 年至2017 年間在秘魯利馬初次感染HIV 期間（29 名立即開始抗反轉錄病毒治療的男性和37 名延遲治療的男性）精液和血漿中的HIV 病毒載量。在這項前瞻性試驗中，參與者最初被隨機分配到兩組的患者均接受治療，但延遲組患者如果在24 週前符合當地治療標準，就會接受治療，然後在治療開始時進行審查，共有66 人完成了研究。

在基準線時，83% 的參與者精液病毒量>1,000 拷貝/mL，顯示病毒有可能繼續傳播。 在 35% 的未經治療的參與者中，這一水平一直保持到他們參與研究結束。 在接受治療的參與者中，精液病毒量迅速下降，其中 25 名參與者在第 12 週時精液病毒量達到 < 1,000 拷貝/mL。

在基準線時，立即治療組的血漿病毒量略高於延遲治療組。 到第 24 週，27 名參與者將精液病毒量降至≤160 拷貝/mL（定義為病毒抑制），同時血漿病毒量持續>40 拷貝/mL（病毒抑制閾值）。 在研究過程中，延遲治療組的血漿病毒量測量值均高於立即治療組。

到第 12 週，立即治療組的 7 名參與者和延遲治療組的 23 名參與者被診斷出患有性傳播感染。所有直接參與者中除一名外他們的精液病毒量均受到抑制，但延遲組的 13 名參與者精液病毒量上升了 >1,000 拷貝/mL。

討論要點和實踐啟示

作者報告了研究限制，包括樣本量小和自我報告的行為數據。

研究人員表示，他們的研究結果顯示，在原發性愛滋病毒感染的最初幾週內，精液病毒量很高，而血漿病毒量（更常用的測量方法）是同一時期精液病毒載量的良好但保守的預測指標。 此外，他們報告說，幾乎所有接受抗病毒治療的參與者在診斷出另一種性傳播感染後，精液病毒量仍保持在抑制狀態，而延遲治療組中的許多人則不然。

他們總結道，結果顯示了愛滋病毒檢測、快速與診斷照護連結以及立即開始治療以減少愛滋病毒進一步傳播的重要性。

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With Immediate Treatment of HIV, Semen Viral Load Drops Rapidly, Reports Small Study

Barbara Jungwirth /  Jan 9, 2024 / TheBodyPro

Starting antiretroviral treatment immediately upon HIV diagnosis not only helps preserve a person’s health, but also quickly reduces semen viral load to levels where the virus is unlikely to be transmitted, according to the results of a small study conducted in Peru.

About This Study

“Viral load dynamics in plasma and semen when ART is initiated during early HIV-1 infection“ was published online as a brief report on Nov. 24, 2023, in The Journal of Infectious Diseases. The lead authors are Trupti Gilada, M.D., M.B.B.S., of the Unison Medicare & Research Center in Mumbai, India, and Angela K. Ulrich, Ph.D., M.P.H., of the Center for Infectious Disease Research and Policy, and the Division of Environmental Health Science, both at the University of Minnesota in Minneapolis. Study drugs were donated by their manufacturers, Gilead Sciences and Merck Sharp & Dohme Corp., respectively.

Key Research Findings

Researchers assessed HIV viral loads in semen and plasma during primary HIV infection–29 men who started antiretroviral treatment immediately and 37 men who delayed treatment–in Lima, Peru, between 2013 and 2017. In this prospective trial, participants were initially randomized to the two arms, but those in the delayed arm were offered treatment if they met local treatment criteria prior to 24 weeks and were then censored on treatment start, with 66 individuals completing the study.

At baseline, semen viral load was >1,000 copies/mL in 83% of all participants, indicating potential onward transmission of the virus. In 35% of untreated participants, that level remained through the end of their study participation. In treated participants, semen viral load declined rapidly, with 25 participants achieving < 1,000 copies/mL by week 12.

Plasma viral load was slightly higher in the immediate vs. the deferred treatment arm at baseline. By week 24, 27 participants had reduced semen viral load to ≤160 copies/mL–defined as viral suppression–while continuing to have plasma viral loads >40 copies/mL, the viral suppression threshold. Over the course of the study, plasma viral load measurements were higher in the deferred vs. the immediate treatment arm.

By week 12, seven participants in the immediate and 23 in the deferred treatment arm were diagnosed with a sexually transmitted infection. Semen viral load remained suppressed in all but one participant in the immediate arm but rose >1,000 copies/mL in 13 participants in the deferred arm.

Discussion Highlights and Implications for Practice

Study limitations reported by the authors included the small sample size and self-reported behavioral data.

The researchers said their findings suggest there is a high semen viral load during the early weeks of a primary HIV infection and that plasma viral load, the more commonly available measure, is a good but conservative predictor of semen viral load during this same time period. In addition, they reported that almost all participants treated with antiretroviral therapy maintained suppressed semen viral loads after a diagnosis of another sexually transmitted infection while many in the deferred treatment group did not.

Results show the importance of HIV testing, rapid linkage to care on diagnosis, and an immediate treatment start for reducing onward HIV transmissions, they concluded.

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