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Seminal HIV-1 RNA Detection in Heterosexual African Men Initiating Antiretroviral Therapy. BACKGROUND: Intermittent shedding of human immunodeficiency virus type 1 (HIV) in semen occurs despite effective antiretroviral therapy (ART) and suppressed blood HIV-1 RNA levels. METHODS: We assessed the frequency, magnitude, and correlates of seminal HIV-1 RNA shedding in HIV-1-infected African men initiating ART. RESULTS: Seminal HIV-1 RNA was detected in 24% (37 of 155), 10% (5 of 49), and 11% (8 of 70) of samples collected 0-3, 4-6, and >6 months after ART initiation. When blood HIV-1 levels were suppressed, seminal HIV-1 RNA was detected in 8% (16 of 195), and 82% (13 of 16) had an HIV-1 RNA load of < 1000 copies/mL. CONCLUSIONS: Seminal HIV-1 RNA shedding was infrequent and present at low levels in HIV-1-infected African men with suppressed blood HIV-1 RNA.