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Correlation of VL in semen with VL in blood - and PRPI

Aug 8, 2010

Hello Dr. Holodniy,

A few weeks ago I submitted two questions to which I have yet to see a reply. Truthfully, I'm not certain that I submitted them to the correct forum as none of the active forums seemed to be a good fit. If this isn't the correct forum, could you please direct me to the right one?

1) My first question concerns the correlation of VL in semen with that in blood. I've read of some recent studies (Swiss and Danish to be specific) that seem to indicate a negligible risk of transmission if the infected individual has an undetectable VL. But, in hetero vaginal sex, isn't the route of transmission via the male's semen? It would seem a relatively simple matter to conduct a study that correlates the VL assay in a person's semen with the VL assay in blood at a given point in time. Yet, I've not even seen such a study discussed? What am I missing here?

2) My second question concerns a procedure that has become common in orthopedic surgeries called platelet rich plasma injection (PRPI) in which a sample of the patient's blood is drawn and spun down to concentrate the red blood cells. These are then reinjected into the wounded area, the thinking being that the oxygen rich platelets help speed healing. Would there be an issue performing such a procedure on a person who is hiv+? If so, would the concern be greater with a sample of blood that has a higher VL?

Thanks for your help with these two questions.

Response from Dr. Holodniy

Several studies have been published addressing this question. In general, HIV viral load is detectable in seminal fluid and tends to be about 10-100 fold lower in seminal fluid than plasma. In addition, mononuclear cells in semen also include cells that are HIV infected but HIV viral load is usually not quantified from these cells.

There is no reason that platelet enriched plasma could not be used in wound healing. Yes, there is a theoretical risk of using one's plasma that contains HIV, but it is likely that the positive effects of concentrated platelets in wound healing outweighs the negative effects of transiently increased viral load in the wound. But there is no data to answer this question.

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