Infection risk when on meds?

[Cerrid]

Here's a simple question which has been bothering me for some time now and while I'm well aware that it might put prevention efforts into an awkward position, I hope you can shed some light on this...

Are there any reports, studies or first hand or second hand experiences that someone on meds, who has had an undetectable viral load for several months in a row, has infected a negative person whilst having unprotected sex?

[thirtysomething]

Hi Cerrid,

There is a good chance of infecting someone even with undetectable VL. If I'm not wrong 'Undetectable' means that the virus is <50 mm copies in the blood and not in the semen.

My opinion is always use a latex rubber while having sex!

[Cerrid]

There is a good chance of infecting someone even with undetectable VL. If I'm not wrong 'Undetectable' means that the virus is <50 mm copies in the blood and not in the semen.

Thank you thirty! That's what I learned, too. However, if there's a "good chance" for infection despite a persisting undetectable viral load, then there should be plenty of proofs, studies and personal experiences where this has actually happened. That's what I'm looking for.

[RapidRod]

Just because one is not detectable does not mean you can not infect them.

[J.R.E.]

The viral load can be higher in the semen even though it shows as undetectable in the blood. There is always a risk of infecting someone if no condom is used.

Ray

[J.R.E.]

And here's a related article from the "News Section"

http://www.aidsmeds.com/articles/1667_12327.shtml

Ray

[Ulong]

And here's a related article from the "News Section"

And one for the ladies (though men need to check out this link too, for the reasons I mention below) : Even if your viral load is undetectable, your vaginal secretions still got the package. And the same as men, genital viral load is almost always higher than the viral load in your blood. Other risk factors for higher shedding of virus, uh, "down there" included multiple sex parners and smoking cigarettes.

The most interesting risk factor was that they found higher genital viral loads of women on Sustiva-based regimens vs. PI based ones. Wonder if this is true for the guys...does being on a PI regimen make you less likely to have undetectable VL in semen?

http://www.aidsmeds.com/articles/1667_11071.shtml


But back to the original question.... This Spanish study followed 62 couples who were of mixed status trying to conceive babies the old-fashioned way. None of the partners was infected, but one baby was.

http://www.poz.com/articles/1667_10825.shtml

Despite searching around for an exhausting two minutes, I can find no studies/stories where someone was infected by an undetectable partner. Surely someone can find one. I obviously am incapable of doing so without more coffee. Plus I need to go get a life.

[Cerrid]

But back to the original question.... This Spanish study followed 62 couples who were of mixed status trying to conceive babies the old-fashioned way. None of the partners was infected, but one baby was.

http://www.poz.com/articles/1667_10825.shtml

Thank you Ulong! That's a very interesting study. I'm not sure if this 2005 Spanish study is the same because in the summary, they don't talk about babies. But I think it's the same cohort of 393 heterosexual couples: "The investigators found that HIV was only transmitted by patients who were not taking anti-HIV therapy. Not a single partner of an HIV-positive patient taking anti-HIV therapy became infected with HIV."

The investigators conclude that "after the introduction of HAART, an important decrease in HIV transmission has been observed in a thoroughly studied group of steady heterosexual couples, irrespective of any changes in other factors that could affect transmission", i.e. behaviour and STD.

Despite searching around for an exhausting two minutes, I can find no studies/stories where someone was infected by an undetectable partner. Surely someone can find one.

Thank you, I'll try to continue my search as well.

[Bucko]

Cerrie-

As much as I understand your desire to keep the field of candidates as open as possible and a longing to return to pre-poz days, I'll counsel you as strongly as possible to serosort. It's the best course of action possible, IMHO.

Hugs-
Brent
(Who knows Cerrie to be a man of honor)

[Ulong]

I'm not sure if this 2005 Spanish study is the same because in the summary, they don't talk about babies. But I think it's the same cohort of 393 heterosexual couples

Maybe the study I cited was a cohort of your study, they were published about a year apart and it included 62 couples. It's not outlandish to think they could have found them out of that 393 and studied them seperately. The main difference between them is that with the 62 couples, all were known to be having unprotected sex at least some of the time since the women got pregnant. That's a fair number of certain exposures without any infections.

But listen to part of your Uncle Brent's advice and don't run wild. I don't agree with serosorting since it's very difficult if you're not a gay man (sorry guys, but it's true.) So I look at keeping my VL low as an addition to safer sex, not a substitute. Do both and you increase the odds of not infecting partners to a very high degree--- one with which I can deal with more easily.

[Bucko]

But listen to part of your Uncle Brent's advice and don't run wild. I don't agree with serosorting since it's very difficult if you're not a gay man (sorry guys, but it's true.) So I look at keeping my VL low as an addition to safer sex, not a substitute. Do both and you increase the odds of not infecting partners to a very high degree--- one with which I can deal with more easily.

Forgive me, Ullie. I was discussing the serosorting paradigm with the understanding that we were talking man-to-man. I understand that dealing with mixed-sex relationships/hook-ups is a totally different can of worms.

Brent
(Who can forget the diversity of our membership from time to time)

[Cerrid]

Buckster and Ulong, thanks for your advice. Personally, I do serosort if possible and I like it. Sex is not as stressful and there's one worry less. However, I'm not living in a gay metropole, so there just isn't enough decent poz dating material around. That's why I play with the neg guys as well, but it's mutual and safe and I'm generally happy with the situation.

Back to topic: The scientific data I found are scarce (there's another cohort study from Uganda) and they only investigated heterosexual couples where they found that HAART reduces the infection rates significantly. So that's the good side: it shows that starting meds earlier can be beneficial for prevention i.e. the sooner one gets undetectable, the lower the risk of infecting someone else. Main criteria: Viral load and genital ulceration.

I searched a bit more and found that Swiss health officials now state that the transmission risk of unprotected sex with an undetectable VL is about the same as a french kiss... they say it's basically negligible. Although semen still contains virus copies, it seems like the virus concentration is not high enough to cause an infection, similar to saliva, urine and tears. I couldn't find a study though how they  back this claim but there should be some medical evidence somewhere otherwise they wouldn't claim it. They're officials.

However, I'm hesitant to transfer these conclusions to homosex and (why not?) needle sharing. Not for rational reasons, but for the feeling. It's not my intention to advocate for no condoms in discordant couples, au contraire. You never know if you or your partner is indeed undetectable, you don't know his adherence, there can be viral blips, there can be STDs which facilitate transmission etc. On the other hand, I still haven't found a report or study where an undetectable person has indeed infected his partner...