Post-Prostatic Massage Fluid/Urine (post-PMF/U) as an Alternative to Semen for Studying Male Genitourinary HIV-1 Shedding

Objectives—Genitourinary tract samples are required to investigate male HIV-1 infectivity. Because semen collection is often impractical, we evaluated the acceptability, feasibility, and validity of post-prostatic massage fluid/urine (post-PMF/U) for studying male genitourinary HIV-1 shedding. Methods—HIV-1-seropositive men were evaluated after 48 hours of sexual abstinence. At each visit, a clinician performed prostatic massage, then post-PMF/U and blood were collected. Participants provided semen specimens one week later. An audio computer-assisted self-interview (ACASI) administered after each specimen collection evaluated acceptability, adherence to instructions, and recent genitourinary symptoms. HIV-1 RNA was quantified using a real-time PCR assay. Detection and quantitation of HIV-1 RNA and stability over visits were compared for semen, post-PMF/U, and blood. Corresponding author and request for reprints: Susan M. Graham, MD, MPH, University of Washington Box 359909, 325 Ninth Avenue, Seattle, WA 98104-2499 Phone: 206-543-4278, Fax: 206-543-4818 [email protected]. Contributors. RWC, JNK, and SMG conceived the study; RWC was principal investigator; SMG, JNK, RSM, NMP, EJS, and RWC contributed to study design; SMG was the lead author for the paper; SMG and SEH performed the statistical analysis; SMG, PLMG, LWW, and SW supervised conduct of the study; KMR, JAD, CHM, KNM, and RWC supervised laboratory protocols and testing; and all authors contributed to the write up. Competing interests. None declared for all authors. Licence agreement. The Corresponding Author has the right to grant on behalf of all authors and does grant on behalf of all authors, an exclusive licence (or non exclusive for government employees) on a worldwide basis to the BMJ Publishing Group Ltd to permit this article (if accepted) to be published in STI and any other BMJPGL products and sub-licences such use and exploit all subsidiary rights, as set out in our licence: http://group.bmj.com/products/journals/instructions-for-authors/licence-forms. These data were presented in part at the 5th IAS Conference on HIV Pathogenesis, Treatment, and Prevention, Cape Town, South Africa, July 2009. NIH Public Access Author Manuscript Sex Transm Infect. Author manuscript; available in PMC 2012 April 1. Published in final edited form as: Sex Transm Infect. 2011 April ; 87(3): 232–237. doi:10.1136/sti.2010.047118. N IH PA Athor M anscript N IH PA Athor M anscript N IH PA Athor M anscript Results—Post-PMF/U was successfully obtained at 106 visits (64%) and semen at 136 visits (81%, p<0.001). In ACASI, discomfort was rated higher for post-PMF/U collection (p=0.003), but there was no significant difference in acceptability. Detection of HIV-1 RNA in post-PMF/U was associated with detection in semen (p=0.02). Semen and post-PMF/U HIV-1 RNA levels were correlated (ρ=0.657, p<0.001). Concordance of results at repeat visits was 78.9% for post-PMF/U (κ = 0.519, p = 0.02), and 89.5% for both blood and semen (κ = 0.774, p = 0.001). Conclusions—Although semen collections were more successful, both post-PMF/U and semen collections were acceptable to many participants. HIV-1 RNA detection and levels were closely associated in semen and post-PMF/U, and results were relatively stable across visits. To assess male HIV-1 infectivity, post-PMF/U may represent a valid alternative when semen cannot be obtained.