Standing in the way of eradication: HIV-1 infection and treatment in the male genital tract.

As a result of the introduction of the Highly Active Antiretroviral Therapy (HAART) many HIV-1 infected individuals are able to live an improved and extended life style that can include the prospect of having children. Problematically, the male reproductive organs may contribute infected cells and free viral particles to semen in these individuals, increasing the risk of infection from the HIV-1 positive male to the mother and ultimately to the offspring. Though autopsies of AIDS infected individuals have taught us a great deal about specific cell loss and the deterioration of male organs in this setting, it is not clear whether the damage is due to specific targeting of these cells and tissues by HIV-1 or an indirect consequence of viral dissemination in the later stages of infection. Due to lack of access to these organs in the early stages of the disease, little is known about the progression and pathogenesis of the infection within them, particularly during the asymptomatic stage. The molecular and cellular aspects of transmission of this virus remain unclear. Although assisted reproductive techniques have been successfully used to achieve pregnancies in discordant couples in the developed world, investigating the mechanism of the spread of HIV-1 in the cells and tissues of the male reproductive tract remains a critical task, not only to improve our understanding, but also to enable the design of suitable treatment for the eradication of the infection from this potential sanctuary site. In this review, we discuss possible mechanisms by which infection of the male genital tract (MGT) may occur in the context of the anatomy and immunology of the tissues of the male reproductive organs. We revisit the methodology used to evaluate the spread and transmission of HIV-1 from these tissues and pinpoint future directions for study that may provide a better understanding of the underlying mechanisms of HIV-1 transmission by this route.