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Post-prostatic massage fluid/urine as an alternative to semen for studying male genitourinary HIV-1 shedding
  1. Susan M Graham1,2,3,4,
  2. John N Krieger1,
  3. Peter L M Githua3,
  4. Lorraine W Wamuyu3,
  5. Steven Wale3,
  6. Kelly M Ramko3,
  7. Joan A Dragavon1,
  8. Charles H Muller1,
  9. Sarah E Holte1,5,
  10. Kishor N Mandaliya6,
  11. R Scott McClelland1,
  12. Norbert M Peshu3,
  13. Eduard J Sanders3,7,
  14. Robert W Coombs1
  1. 1University of Washington, Seattle, Washington, USA
  2. 2University of Nairobi, Nairobi, Kenya
  3. 3Kenya Medical Research Institute, Kilifi, Kenya
  4. 4University of Toronto, Toronto, Ontario, Canada
  5. 5Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
  6. 6Coast Provincial General Hospital, Mombasa, Kenya
  7. 7University of Oxford, Oxford, UK
  1. Correspondence to Dr Susan M. Graham, University of Washington, Box 359909, 325 Ninth Avenue, Seattle, WA 98104-2499, USA; grahamsm{at}


Objectives Genitourinary tract samples are required to investigate male HIV-1 infectivity. Because semen collection is often impractical, the acceptability, feasibility and validity of post-prostatic massage fluid/urine (post-PMF/U) was evaluated for studying male genitourinary HIV-1 shedding.

Methods HIV-1-seropositive men were evaluated after 48 h of sexual abstinence. At each visit, a clinician performed prostatic massage, then post-PMF/U and blood were collected. Participants provided semen specimens 1 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.

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.

  • HIV-1
  • infectivity
  • men
  • prostate
  • semen
  • validation

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  • These data were presented in part at the 5th IAS Conference on HIV Pathogenesis, Treatment, and Prevention, Cape Town, South Africa, July 2009.

  • Funding This study was supported by the National Institutes of Health, grants R21 HD055864 and K23 AI69990 (SMG). Additional support was received from the University of Washington Center for AIDS Research, a National Institutes of Health (NIH)-funded programme (P30-AI027757), which is supported by the following NIH Institutes and Centers (NIAID, NCI, NIMH, NIDA, NICHD, NHLBI, NCCAM). The contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the University of Washington and Kenya Medical Research Institute.

  • Provenance and peer review Not commissioned; externally peer reviewed.