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Author Topic: Why not test semen viral load?  (Read 4869 times)

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Offline vaboi

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Why not test semen viral load?
« on: September 07, 2010, 07:53:02 PM »
I don't see why they don't make it standard practice to test semen hiv viral load in males, along with blood viral load, once the virus becomes undetectable in the blood.  The purpose of this would be to show exactly how contagious one really is.  It would also better serve for research, i.e. people could finally get a better grasp on how likely or unlikely it is to get infected from someone with an undetectable semen and/or blood VL.  It could also give better insight on whether drug resistance in the genital tract is the primary cause of a persistent VL, etc.   From all the studies I've seen, VL is usually lower in the semen than the blood, but this is not guaranteed to always be the case.  Some studies have shown that up to 20% can still have a detectable VL in the semen while being undetectable in blood.  Wouldn't you want to know if you were in this 20%?  I know I would, not only to better protect others, but also to try to figure out how to get it down.. be it changing meds, waiting awhile longer, etc.  Has anyone successfully got their doctor get give such a test when not in any sort of trial?
« Last Edit: September 07, 2010, 07:55:33 PM by vaboi »

Offline jkinatl2

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Re: Why not test semen viral load?
« Reply #1 on: September 07, 2010, 07:56:44 PM »
I dunno if there are ongoing studies, but there certainly HAVE been, which measured semen along with blood to show the sometime discrepancy between viral loads.

As for a regular thing, I don't think my doctor is that cute.
"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline phildinftlaudy

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Re: Why not test semen viral load?
« Reply #2 on: September 07, 2010, 08:05:00 PM »
It would definitely make going for my regular lab work much more interesting and exciting -
As long as I'm allowed to have a cigarette and a nap afterward it would work for me.
September 13, 2008 - diagnosed +
Labs:
Date    CD4    %   VL     Date  CD4  %   VL
10/08  636    35  510   9/09 473  38 2900  12/4/09 Atripla
12/09  540    30    60   
12/10  740    41  <48   
8/11    667    36  <20  
03/12  1,041  42  <20
05/12  1,241  47  <20
08/12   780    37  <20
11/12   549    35  <20
02/12  1,102  42  <20
11/12   549    35  <20

Offline Miss Philicia

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Re: Why not test semen viral load?
« Reply #3 on: September 07, 2010, 08:38:20 PM »
They'll need to keep some copies of Blueboy in the extraction room, though personally I prefer Honcho.
"I’ve slept with enough men to know that I’m not gay"

Offline phildinftlaudy

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Re: Why not test semen viral load?
« Reply #4 on: September 07, 2010, 08:46:33 PM »
They'll need to keep some copies of Blueboy in the extraction room, though personally I prefer Honcho.
or they could co-locate the semen testing lab inside the local adult video booth/bookstore....
September 13, 2008 - diagnosed +
Labs:
Date    CD4    %   VL     Date  CD4  %   VL
10/08  636    35  510   9/09 473  38 2900  12/4/09 Atripla
12/09  540    30    60   
12/10  740    41  <48   
8/11    667    36  <20  
03/12  1,041  42  <20
05/12  1,241  47  <20
08/12   780    37  <20
11/12   549    35  <20
02/12  1,102  42  <20
11/12   549    35  <20

Offline Miss Philicia

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Re: Why not test semen viral load?
« Reply #5 on: September 07, 2010, 08:51:47 PM »
or they could co-locate the semen testing lab inside the local adult video booth/bookstore....

That would be easy for my HIV clinic as there's one right around the corner :) actually two of them, plus a multi-story bath house.  But you know what, queens still get caught having sex in the bathrooms at the clinic.  I mean how messy is that?
"I’ve slept with enough men to know that I’m not gay"

Offline Hellraiser

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Re: Why not test semen viral load?
« Reply #6 on: September 08, 2010, 01:58:20 AM »
I would have to change doctors and get him to work some semen out of me.  Who's that doctor in new york who was in the advertising campaign for something?  You know, the one I'd give a little bit of "who's your daddy" to.

Offline tednlou2

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Re: Why not test semen viral load?
« Reply #7 on: September 08, 2010, 02:22:41 AM »
I would have to change doctors and get him to work some semen out of me.  Who's that doctor in new york who was in the advertising campaign for something?  You know, the one I'd give a little bit of "who's your daddy" to.

Are you talking about Dr. Frank Spinelli?  He's in a commercial for Avadart or something like that.  Miss P had a pic of him I think in an ad about HIV with some goodlookin guy with his shirt off. 

Offline Miss Philicia

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Re: Why not test semen viral load?
« Reply #8 on: September 08, 2010, 02:39:37 AM »
Are you talking about Dr. Frank Spinelli?  He's in a commercial for Avadart or something like that.  Miss P had a pic of him I think in an ad about HIV with some goodlookin guy with his shirt off. 

Do you keep a notebook of my posts?  Even I couldn't remember that queer's name.
"I’ve slept with enough men to know that I’m not gay"

Offline tednlou2

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Re: Why not test semen viral load?
« Reply #9 on: September 08, 2010, 02:56:41 AM »
Do you keep a notebook of my posts?  Even I couldn't remember that queer's name.

Lol.  No, there was some post where I made a comment about him being in an ad for avadart.  I think it was a post about docs pushing meds for financial reasons...I think.  See, I can't remember.  I think it was you who knew about him and posted a pic of him.

About the cum testing, there was that report last week about HIV being different in semen than blood.  I also remember a question to one of the docs at thebody or Dr. Gallant.  This person wondered whether checking CD4 and viral load in lymph nodes would be more accurate.  I think the doc said very possibly, but it would hurt to have a needle stuck in your groin and would not be as easy as a blood draw--obviously; labs to do that kind of testing would be a problem and repeated tissue sample removal not a good idea. 

Offline edfu

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Re: Why not test semen viral load?
« Reply #10 on: September 08, 2010, 03:24:29 AM »
"No one will ever be free so long as there are pestilences."--Albert Camus, "The Plague"

"Mankind can never be free until the last brick in the last church falls on the head of the last priest."--Voltaire

Offline wellington

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Re: Why not test semen viral load?
« Reply #11 on: September 08, 2010, 03:42:35 AM »
Great. So now my lab appointments will be 2 hours long or involve an overnight stay? I better get loyalty points.

I could see a spin off of this involving the testing of mopped up dark room floors at the local bathhouse with a gasoline like display of numbers outside to let you know the expected risk level of your planned visit.

Offline mecch

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Re: Why not test semen viral load?
« Reply #12 on: September 08, 2010, 07:20:34 AM »
But you know what, queens still get caught having sex in the bathrooms at the clinic.  I mean how messy is that?

That is pretty dire, but hilarious.
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline mecch

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Re: Why not test semen viral load?
« Reply #13 on: September 08, 2010, 07:23:26 AM »
As for the topic, did the research show that the viral loads in semen loads varies alot and frequently.  I would guess it goes up and down a lot.   ;D
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline Miss Philicia

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Re: Why not test semen viral load?
« Reply #14 on: September 08, 2010, 09:34:51 AM »
The beautiful Dr. Spinelli:

http://frankspinellimd.com/BioSpinelli.html

and his blog:

http://spinellimd.wordpress.com/






Looking at him with his boyfriend, Chad, on Facebook all I can see is two big pairs of stiletto heels.
"I’ve slept with enough men to know that I’m not gay"

Offline Hellraiser

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Re: Why not test semen viral load?
« Reply #15 on: September 08, 2010, 10:20:46 AM »
Looking at him with his boyfriend, Chad, on Facebook all I can see is two big pairs of stiletto heels.

Is he a queen?  There goes my hard on.

Offline Boze

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Re: Why not test semen viral load?
« Reply #16 on: September 08, 2010, 06:42:27 PM »
The beautiful Dr. Spinelli:

http://frankspinellimd.com/BioSpinelli.html



Man, most guys are such whores. If I saw a woman doctor who put her photo in a bikini on the front page of her website I would not take her seriously. But he must consider the potential hunk factor to his clientèle to outweigh the negatives.

On the OP - is it possible to request this test, does anybody know?
==========
Aug08 - Seroconversion
Mar10 - Diagnosis; cd4 690 - VL 19,000
Apr10 - cd4 600
May10 - VL 4,500
Jun10 - started Atripla ; VL 113
Jul 10 - UD vl, CD4 590
Aug 10 - UD, CD4 810, 52%
Nov 10 - UD, CD4 980

Offline Matty the Damned

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Re: Why not test semen viral load?
« Reply #17 on: September 08, 2010, 06:58:05 PM »
Man, most guys are such whores. If I saw a woman doctor who put her photo in a bikini on the front page of her website I would not take her seriously. But he must consider the potential hunk factor to his clientèle to outweigh the negatives.

You'd sell your house to be on his patient list. Admit it.

MtD

Offline Boze

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Re: Why not test semen viral load?
« Reply #18 on: September 08, 2010, 07:00:50 PM »
You'd sell your house to be on his patient list. Admit it.

MtD

QED.

I prefer old wrinkled men as my doctors :) 
==========
Aug08 - Seroconversion
Mar10 - Diagnosis; cd4 690 - VL 19,000
Apr10 - cd4 600
May10 - VL 4,500
Jun10 - started Atripla ; VL 113
Jul 10 - UD vl, CD4 590
Aug 10 - UD, CD4 810, 52%
Nov 10 - UD, CD4 980

Offline Matty the Damned

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Re: Why not test semen viral load?
« Reply #19 on: September 08, 2010, 07:06:23 PM »
QED.

I prefer old wrinkled men as my doctors :) 

"To each his own", said the old tart as she kissed the monkey's butt.

MtD

Offline dvinemstre

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Re: Why not test semen viral load?
« Reply #20 on: September 08, 2010, 07:38:43 PM »
Good line of questioning. I actually asked this about vaginal secretions two years ago when I was supposed to be having a hysterectomy (which is now scheduled for Oct). In the meantime I had the good fortune to speak with a researcher at Duke University who is eyeball deep in HIV/AIDS research, writing protocols etc. She stated that 1) testing body fluids other than blood has not been practised outside of research and is not something widely desired in the field (patients aren't interested). I asked, hey, if HIV is present in my cervical mucous, which is supposedly how I can infect a man, then if my cervix is gone then what happens. She said, well, we just don't know because there are no testing protocols for this. However, since your entire body shares the same blood supply, the present research position is to call any fluid from your vagina or penis "genital fluid" and there IS ongoing research at Duke that is working on ways to identify the levels of virus in genital secretions/fluids. I thought this was interesting, maybe it will help.

Offline edfu

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Re: Why not test semen viral load?
« Reply #21 on: September 08, 2010, 09:54:40 PM »
there IS ongoing research at Duke that is working on ways to identify the levels of virus in genital secretions/fluids. I thought this was interesting, maybe it will help.

I was struck by this study, announced two days ago, "High genital HIV levels may persist in women who appear to achieve viral suppression with use of ART":

http://www.aidsmap.com/page/1509765/

This seems to address some of the issues raised by your post.  It seems to me this study is yet another blow to the dangerous (IMHO) and now-notorious Swiss study that alleges viral suppression via ART (along with some other conditions) confers sexual non-infectivity among heterosexuals.

I, too, have often wondered why semen viral loads are not commercially available and are done only in research settings.  I suspect that semen viral loads are highly variable, even when viral load is undetectable in peripheral blood, and thus are not anywhere near 100% accurate over time.   
"No one will ever be free so long as there are pestilences."--Albert Camus, "The Plague"

"Mankind can never be free until the last brick in the last church falls on the head of the last priest."--Voltaire

Offline vaboi

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Re: Why not test semen viral load?
« Reply #22 on: September 08, 2010, 10:11:11 PM »
As for the topic, did the research show that the viral loads in semen loads varies alot and frequently.  I would guess it goes up and down a lot.   ;D

Actually it does vary.  My guess it's because when someone shoots a load, it gets it all out and the virus has to breed again in there to get more "load" built back up.  lol

But the point in testing the cum would be to see if there's a persistent detectable virus there and whether it might be a resistant strain... all important information to know to avoid possibly spreading it.  When a doctor tells someone they are undetectable because of a blood test, most believe this makes them less contagious.  This might very well be true, but you really don't know for sure unless the actual substance likely to do the transmitting is tested and is consistently undetectable as well.

Offline vaboi

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Re: Why not test semen viral load?
« Reply #23 on: September 08, 2010, 10:33:30 PM »
I was struck by this study, announced two days ago, "High genital HIV levels may persist in women who appear to achieve viral suppression with use of ART":

http://www.aidsmap.com/page/1509765/

This seems to address some of the issues raised by your post.  It seems to me this study is yet another blow to the dangerous (IMHO) and now-notorious Swiss study that alleges viral suppression via ART (along with some other conditions) confers sexual non-infectivity among heterosexuals.

I, too, have often wondered why semen viral loads are not commercially available and are done only in research settings.  I suspect that semen viral loads are highly variable, even when viral load is undetectable in peripheral blood, and thus are not anywhere near 100% accurate over time.   


They refuted the Swiss study by doing the research into semen VL levels of undetectable people.  The research found that generally semen as undetectable as well, but something like 20% still had detectable semen viral load be it from declining slower, resistant reservoir, etc.  Whether the RNA found was actually transmittable virus was also uncertain.  Then after serious digging, they finally found a documented case where it was allegedly transmitted from someone who was blood undetectable. Wow.. they finally found ONE case.  lol  But of course the guy's semen level was never tested.  I don't get why the Swiss don't come back and say, well, if they have undetectable semen VL, then they are definitely non-contagious and recommend such testing for anyone who becomes blood undetectable.  It's just common sense.

Offline edfu

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Re: Why not test semen viral load?
« Reply #24 on: September 08, 2010, 11:25:35 PM »
Do the scientists understand what explains the variability of semen VL level amongst those who are undetectable in peripheral blood, or what causes spikes in the semen VL level?  Does anyone really know if the semen VL level is undetectable at a given point, that it will not become detectable two days, two weeks, two months, etc., later, and, if so, what causes this, even though the peripheral blood is VL-undetectable all along?     
"No one will ever be free so long as there are pestilences."--Albert Camus, "The Plague"

"Mankind can never be free until the last brick in the last church falls on the head of the last priest."--Voltaire

Offline fearless

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Re: Why not test semen viral load?
« Reply #25 on: September 09, 2010, 01:30:09 AM »
Looking at him with his boyfriend, Chad, on Facebook all I can see is two big pairs of stiletto heels.

Yeah. Mincer
Be forgiving, be grateful, be optimistic

Offline terpie82

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Re: Why not test semen viral load?
« Reply #26 on: September 09, 2010, 04:31:06 AM »
The Swiss study although controversial, shows a strong corelation between being plasma undetectable and less likely to be infectious. Statistics is never absolute, but to improve statistical significance, they had a sample size (n) of 6168 patients. This second and more recent study points out the need for quantifying the VL in vaginal/penile secretions (in addition to plasma VL confirmation) with a sample size (n) of 59 (female) patients. An improvement indeed, which is the nature of science...one study builds and advances from the previous. Both studies are sound and both yield important data, and neither should be disregarded. It is even possible that the second study may not have been initiated had the former massive study not taken place.

edfu, you raise some pertinant questions that scientists still don't know the answer to. There is often VL variability between tissues and even between cells within the same tissue and even in the same tissue at different times. These are a lot of variability and you add in variability between patients, you can get an idea of how no research study is completely adequate. There's so much we still don't know, so much we still don't understand, and so many variables.

vaboi does raises a good point. HIV is often transmitted through sexual contact via vaginal/penile excretions, so the direct assessment of vaginal/semen VL is the most logical step and one of the key points in this most recent study. However, a lot of clinics are ill-equipped to handle the move as of yet. Here at the National Institutes of Health, the largest and most prestigious health-related research center in the world, the patient clinic has two lavatories where patients can provide urine samples for their respective studies. And that’s after a major renovation of the building 10 clinic in the triple digit million dollars. We’ll get there. Hopefully by then, there’ll be a nice, clean, quiet room with nice things to look at, where I’ll graciously contribute my army to a worthy study. Until then, I’ll continue to donate my plasma to science, which I’ll actually be doing in 3 hours so I bid adieu.
Diagnosed in 2003
UD since 2004 and >35% (with one blip)

Offline jkinatl2

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Re: Why not test semen viral load?
« Reply #27 on: September 09, 2010, 04:47:38 AM »
Thanks, terpie82.... I was almost inclined to to the research necessary to post rebuttals, but found it exhausting.

Voice of reason FTW.
"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

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