DNA Not Detected in Semen of Men with Chronic Hepatitis B Successfully
Treated with Nucleotide Analogs
HIV positive and negative men with chronic hepatitis B who
achieved undetectable serum HBV DNA during treatment with
nucleotide analogs such as tenofovir (Viread) also cleared
HBV genetic material in their semen, suggesting a reduced
risk of sexual transmission, according to a poster presented
at the 17th Conference on Retroviruses & Opportunistic
Infections (CROI 2010) this week in San Francisco.
hepatitis B virus is a sexually transmitted
infection, and men who have sex with men are at elevated risk. Prior
studies indicate that sexual transmission is uncommon among HBV monoinfected
people who suppress serum HBV DNA to an undetectable level with antiviral
therapy. However, research has shown that HIV RNA can remain in the
semen even after it falls to an undetectable level in the blood with
Ann Marie Liapakis from New York Presbyterian Weill Cornell Medical
Center and colleagues aimed to determine whether HBV DNA -- like HIV
RNA -- would remain detectable in the semen of HIV positive and negative
men with chronic hepatitis B who achieved serum HBV viral load suppression
with nucleotide antiviral therapy that penetrates the semen compartment.
Studies of HIV positive men have shown that tenofovir
penetrates the genital compartment, which is protected by a physiological
barrier that keeps some drugs out.
Several antiviral medications are approved for treatment of chronic
hepatitis B, including two nucleotide analogs, tenofovir -- indicated
for treatment of both HBV and HIV -- and adefovir
(Hepsera). Treatment guidelines recommend that HIV/HBV coinfected
patients should be treated with at least 2 dually active agents, such
as tenofovir plus either lamivudine
(Epivir) or emtricitabine
This cross-sectional study included 20 men with chronic HBV infection,
as indicated by being hepatitis B surface antigen (HBsAg) positive and
either positive or negative for hepatitis B "e" antigen (HBeAg).
Participants provided blood and semen samples for HBV DNA quantification.
Semen was tested using the high-sensitivity HBV TaqMan real-time polymerase
chain reaction (PCR) assay, with a limit of detection of 5 IU/mL.
The researchers compared semen HBV DNA levels of 10 men using tenofovir
or adefovir who had undetectable serum HBV DNA (< 100 IU/mL) and
10 men with detectable blood HBV DNA.
Characteristics of the participants in the 2 groups were comparable
overall, except the men in the serum detectable group were significantly
younger on average (mean 35 vs 47 years). Also, 3 of the 10 men in the
serum undetectable group and 1 in the serum detectable group were coinfected
with HIV. In both groups, 3 patients were HBeAg positive.
In the serum undetectable group, 4 men were taking adefovir, 3 were
taking tenofovir as the only anti-HBV drug, and 3 were taking tenofovir
plus emtricitabine (the drugs in the Truvada
pill). In addition, the sole HIV/HBV coinfected participant in the serum
detectable group was also on tenofovir/emtricitabine.
men with undetectable serum HBV DNA, none had detectable semen HBV
3 of the 10 men with detectable blood HBV DNA also had detectable
virus in their semen.
3 men had semen HBV DNA viral loads of 6 IU/mL, 344 IU/mL, and 1190
3 of these men had very high blood HBV DNA, at 70,900 IU/mL, 338
million IU/mL, and 27 million IU/mL, respectively.
contrast, the remaining 7 men in the serum undetectable group who
also had undetectable semen viral load had a median blood HBV DNA
level of 11,000 IU/mL.
sole coinfected man in the serum detectable group was among the
3 with detectable semen viral load.
of the 3 men with detectable serum and semen HBV DNA were HBeAg
7 men with detectable serum but undetectable semen HBV DNA, however,
were HBeAg negative.
this cross-sectional analysis, HBV DNA was not detected in the semen
of patients with undetectable blood level as a result of nucleotide
antiviral therapy," the investigators concluded.
"These results suggest that HBV may not be transmitted sexually
when serum negativity is achieved via antiviral suppression or alternatively
may reflect the lack of sensitivity of the PCR assay in the semen. These
findings should be confirmed in studies of larger sample size."
New York Presbyterian Weill Cornell Medical Center, New York, NY;
Warren Alpert Medical School of Brown University, Rhode Island Hospital,
Providence, RI; Mt. Sinai Med Center, New York, NY.
Liapakis, M Patel, E Kula, and others. HBV DNA Is Not Detected in the
Semen of Patients with Chronic Hepatitis B and Undetectable Serum HBV
DNA as a Result of Nucleotide Antiviral Treatment. 17th Conference on
Retroviruses & Opportunistic Infections (CROI 2010). San Francisco.
February 16-19, 2010. Abstract 627.