exosomes. Infectivity studies by HIV-infected ART-naïve SE revealed that SE from healthy donors and HIV-infected donors are inhibitory, but BE are not inhibitory. Therefore, the inhibitory phenotype of SE is conserved regardless of donor HIV status. Significantly, BE and SE from HIV-infected ART-suppressed donors not only inhibited HIV-1, but contained inhibitory levels of antiretroviral (ARV) medications, indicating that body-fluid derived exosomes may act as carriers of ARV drugs. Previous studies found that the antiviral mechanism of SE was targeted to multiple HIV-1 lifecycle steps; however, the mechanism of inhibition was unclear. Transcription specific analysis revealed that SE reduced HIV-transcription at multiple steps including association of transcription factors NF-kB and Pol II with the viral promoter, as well as transcription initiation and elongation. SE inhibited HIV-driven promoter activation and viral gene expression. Importantly, SE targeted inhibition of viral protein Tat transcriptional activities. Overall, these findings from donor characteristics that may alter the condition of the cellular source of SE demonstrate that SE antiviral factor(s) is highly conserved. Illicit drugs alter SE-associated factors and may reduce SE inhibitory activities. However, HIV status does not affect the antiviral function of SE. Significantly, donor-ARV medications are associated with SE and BE indicating a potential role of exosomes in drug delivery in vivo. Mechanistically, SE suppress HIV-1 by targeting host and viral transcription factors that could be therapeutically exploited for novel anti-HIV strategies. These data emphasize the need for additional studies on the composition and function of SE to harness the antiviral potential of SE inhibitory factors. v PUBLIC ABSTRACT Exosomes are nano-sized vesicles released from most cell types and are found in most body fluids. Healthy cells and cells infected with different viruses release exosomes that may inhibit or enhance infection. Recent research showed that exosomes found in semen of healthy human donors inhibit HIV infection, but that exosomes from blood do not. We tested whether exosomes from HIV-infected donors inhibit HIV, and found that semen exosomes from HIVinfected donors inhibit infection regardless of whether donors are on anti-HIV medications or not on medication. HIV-infected donors' blood exosomes inhibit HIV if the donor is on anti-HIV medications, but do not inhibit if they are not on anti-HIV medications. We found that this was due to exosomes packaging the anti-HIV drugs taken by the HIV-infected donors. Illicit drug use is associated with increased susceptibility to HIV and worsening disease, and may cause changes in both the male reproductive tract and generation of exosomes. We determined that donor illicit drug use altered semen exosomes by changing exosomes composition, and these exosomes were less able to inhibit HIV-1 infection. We investigated how semen exosomes inhibit HIV and found that they restrict the virus from copying its ge...