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Author Topic: "HIV-unprotected sex is possible" ?  (Read 29006 times)

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Offline John2038

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"HIV-unprotected sex is possible" ?
« on: January 30, 2008, 11:48:06 AM »
You probably have heard the arguments of Pr Bernard Hirschel about having unprotected sex while successfully on HAART since months.

Here is a news extract of an article published in a swiss newspaper today.

HIV: unprotected sex are possible

A person infected with HIV and receiving an effective HAART does not transmit the virus during sex. T
This is the conclusion of a study of 393 heterosexual couples in which one partner is infected.

The Federal Commission of AIDS (CFS) has arrived at this conclusion after reading scientific facts and after lengthy deliberations, "said the Swiss Medical (FMH).

Three conditions must be met for the virus to not be transmitted through sexual contact.
First, the therapy must have "remove" the virus in the blood (undetectable) for at least six months.
Secondly, the antiretroviral therapy should be systematically followed (100% adherence) by the patient and monitored regularly by a doctor.
Lastly, the patient should not be suffering from another sexually transmitted infection.

http://www.tdg.ch/pages/home/tribune_de_geneve/info_express/suisse/depeches_suisse/(contenu)/188233


Question

We can't predict neither a therapeutic nor a virologic failure, as well as a blip.

As such, unprotected sex can't be safe no ? (so it's just a matter of time for the neg partner to be infected)
« Last Edit: January 30, 2008, 12:54:45 PM by John2038 »

Offline Cerrid

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Re: "HIV-unprotected sex is possible" ?
« Reply #1 on: January 30, 2008, 06:25:10 PM »
We can't predict neither a therapeutic nor a virologic failure, as well as a blip.

As such, unprotected sex can't be safe no ? (so it's just a matter of time for the neg partner to be infected)

Just read what you quoted yourself, the answer lies within: If there's a therapeutic or virologic failure, then HAART is ineffective and condition 1 isn't met. Only if ALL three conditions are met at the same time, no transmission can take place. Obviously, only the monitoring doctor can tell if all conditions are met.

If one or more of the conditions aren't met, then the Swiss docs say that the usual Safer Sex guidelines should be followed. They make this point very clear in their original statement, but the newspaper you quoted has omitted it. Here's the statement in full length (german and french versions). As you can see, Safer Sex guidelines are still valid. They're only extended for a well defined set of conditions, limited to a small group of people.

There is enough evidence to support this claim and the Swiss health officials are quite progressive to go public with it, unbiased by ideological, political or religious beliefs. The Federal Commission of AIDS which has come forward with this statement is a medical institution issuing guidelines and consulting the government.



"Boredom is always counterrevolutionary. Always." (Guy Debord)

Offline CallMeSid

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Re: "HIV-unprotected sex is possible" ?
« Reply #2 on: January 30, 2008, 11:52:03 PM »
Hmmm...what if you're not on meds but your VL is undetectable nonetheless?

Hmmm...it sounds like they studied only heterosexual couples with 1 POZ partner and 1 NEG partner?  Can we assume their findings are relevant to gay male couples and gay men who are not a part of a couple?

I dunno.  While I believe the risk of transmission is very low under these circumstances, I don't think it's "zero"....
07/2006 HIV-negative
06/2007 HIV-positive
07/2007 CD4: 795 (40%), VL: <50
09/2007 CD4: 629 (43%), VL: 895  (~2 weeks after measles/mumps/rubella booster)
12/2007 CD4: 854 (45%), VL: <50
03/2008 CD4: 880 (45%), VL: 151
12/2008 CD4: 943 (46%), VL: 116
05/2009 CD4: 865 (44%)  VL: 107

Offline Jacques

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Re: "HIV-unprotected sex is possible" ?
« Reply #3 on: January 31, 2008, 01:22:36 AM »
Quote
Hmmm...what if you're not on meds but your VL is undetectable nonetheless?
The Swiss Aid commission have not included that category of undetectables. Only those on effective harrt are concerned.

 
Quote
Can we assume their findings are relevant to gay male couples and gay men who are not a part of a couple?


I wish we were, but no : those to whom these new guidelines apply are strictly stable heterosexual couples. I read that Pr Hirschel personally believes that it could also applied tostables gay  couples, but more studies have to be done on that population before including them. I know that a large study is presently being made in France concerning Hiv transmission among gay population. The conclusions have not been released yet.

Quote
I dunno.  While I believe the risk of transmission is very low under these circumstances, I don't think it's "zero"....

They haven't said it was zero, but "the risk is so low that it can be compared to being involved in a plane crash". Perhaps the chance for a  condom do break would be kinda similar ?

I know this is difficult to accept for those who, just like me, have been brainwashed for more than twenty years of hearing: " you are Hiv poz and it is an infectious disease, you shall now wear condom for the rest of your life "

Jacques 
Jacques
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Offline Matty the Damned

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Re: "HIV-unprotected sex is possible" ?
« Reply #4 on: January 31, 2008, 01:39:53 AM »
Matty the Damned isn't sure what fuels Cerrid's fire on this issue. It seems that the only time he opens his mouth it's to talk about how people on HAART can't transmit HIV.

There is enough evidence to support this claim and the Swiss health officials are quite progressive to go public with it, unbiased by ideological, political or religious beliefs. The Federal Commission of AIDS which has come forward with this statement is a medical institution issuing guidelines and consulting the government.


The Swiss support it. It must be ok.

Now Matty the Damned is no member of the Safe Sex Taliban. He's totally in favour of poz bodz going pink-on-pink with each other, provided they accept the real risks of what they're up to. Not the alleged views of a snooty country which is best known for good chocolate, yodeling, Nazi gold, ski slopes and fancy clocks.

The problem with this debate is that it ignores entirely the broader issues of other STD's and what they mean for HIV positive people.

Sure, you're not going to cop a super-infection and even if you do, it's probably no big deal. Chances are, you were going to end up with a resistant strain by virtue of how the virus works in any event.

What the whole "fuck it let's go bare, we've already got the King of STD's" attitude suggest is that you need not be concerned about other STDs.

Like chlamydia, genital warts, gonorrhoea, and the really nasty ones.

Syphilis springs to mind. Hepatitis B is a downer too.

MtD

Offline Jacques

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Re: "HIV-unprotected sex is possible" ?
« Reply #5 on: January 31, 2008, 02:15:46 AM »
Quote
Not the alleged views of a snooty country which is best known for good chocolate, yodeling, Nazi gold, ski slopes and fancy clocks.

 Come on, Matty , those are child arguments. You value better then that. Isn't it?

Matty, mon petit, no one here is talking about  bare backing wildly. The new Swiss guidelines , apply to heterosexual  couples only when partners have no other MTS and no extra conjugal sexual affairs. It is written black on white, like Swiss chocolate on vanilla ice cream  ;D

Jacques
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Offline Matty the Damned

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Re: "HIV-unprotected sex is possible" ?
« Reply #6 on: January 31, 2008, 02:20:34 AM »
You don't post here much, do you?

MtD

Offline Jacques

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Re: "HIV-unprotected sex is possible" ?
« Reply #7 on: January 31, 2008, 02:29:48 AM »
This time you'r right, babe. ;D

It is true, I don't post much. But sometime I like putting my grain of salt.

bisous
Jacques
Jacques
Living positively since 1987
latest lab :july 2010
Undetectable Cd4 1080
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Offline Matty the Damned

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Re: "HIV-unprotected sex is possible" ?
« Reply #8 on: January 31, 2008, 02:38:28 AM »
Good for you, mon petit choux. :)

Allow me then to essay upon the theme.

A single study may indicate that people on HAART or those with an otherwise undetectable viral load don't transmit HIV. But are these odds sufficient that sero-discordant couples should feel they can "take the gamble" and go bareback, because they're like "totally sure" they won't get infected?

I see no evidence that the findings of this research have been replicated by other independent researchers. And this study has no particular merit because it's be conducted by Monsieur le Suisse. No matter what Cerrid might think.

MtD

Offline OneMoreGuy

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Re: "HIV-unprotected sex is possible" ?
« Reply #9 on: January 31, 2008, 02:39:30 AM »
While there are many 'knowns' about HIV transmission, there are still many 'unknowns' too.

I barebacked most of the time I lived in West Hollywood in the late 80s and most of the ten years I lived in San Francisco. I also knew I had many sexual encounters with HIV people. I never got infected and I never got an STD. And no, I wasn't lucky.

So then, what was it? My doctors can't explain it.

However, that never meant to me that the possibility of infection was not there, nor that the possibility of catching an STD was not present.

No matter what new findings about HIV transmission come to light, one cannot loose sight that we are not all created equal. Some people are more susceptible to get infected quicker than others. Sometimes it has to do with how strong our immune system is at any given point.

So, if you want to bareback, go for it. But don't do it because some paper said it was okay to do so.

As with anything in life, we have to take responsibility for what we decide to do and not look to blame any negative outcomes for our actions based on what someone else said.
Psychologist, PhD
Counseling patients with HIV since Jan 1991
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Offline Jacques

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Re: "HIV-unprotected sex is possible" ?
« Reply #10 on: January 31, 2008, 03:05:42 AM »
I just want to remind that we are not talking of one study, or an article of some obscure source.

We are talking of a Western World Country, scientifically reliable, who made public it's new guidelines based on multiple studies from various countries  showing that there is no evidence of Hiv transmission when conditions mentioned above are respected:  as explained by Cerrid who took the time to read and understand them.

Jacques
Jacques
Living positively since 1987
latest lab :july 2010
Undetectable Cd4 1080
43% on Reyataz/Norvir/Truvada

Offline Matty the Damned

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Re: "HIV-unprotected sex is possible" ?
« Reply #11 on: January 31, 2008, 03:07:27 AM »
I just want to remind that we are not talking of one study, or an article of some obscure source.

And you have links to the other studies?

Kthnxbai

MtD

Offline edfu

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Re: "HIV-unprotected sex is possible" ?
« Reply #12 on: January 31, 2008, 08:00:51 AM »
HIV is found to be "undetectable" ONLY in the circulating peripheral blood, but only 2% of CD4 cells in the body, the cells infected by HIV, are found in the peripheral blood.  The other 98% of CD4 cells are found elsewhere, and the VL test is not testing "elsewhere."

HIV is present in the gut, the lymph nodes, the brain, the testes. 

Did the Swiss scientists look for HIV in semen?  Did they prove that HAART made HIV undetectable in all these other places in which HIV "hides" or lies dormant? 

If a VL test is undetectable in the peripheral blood and is therefore, according to the Swiss, incapable of being transmitted, why haven't they also declared that such "undetectables"  are cured?
"No one will ever be free so long as there are pestilences."--Albert Camus, "The Plague"

"Mankind can never be free until the last brick in the last church falls on the head of the last priest."--Voltaire

Offline hartiepie

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Re: "HIV-unprotected sex is possible" ?
« Reply #13 on: January 31, 2008, 08:27:44 AM »
EDFU:

I haven't read the study and the link is in French, so I won't say anything specific to that. However you bring up some interesting questions that probably are not addressed in the study, so it wouldn't surprise me that they wouldn't be addressed in the results.

Based on what is reported here, it wouldn't matter to the results of this study if the virus is present all over in the body's organs as you say because (presumably) every HIV-infected person has virus everywhere which means all participants had the same pre-existing condition.

Being "cured" is a very loaded phrase, and I highly doubt anyone would go there simply because no one reporting on the study here has suggested eradication was occurring -- only that transmission was so low that risk of infection is comparable to other 'common' risks of life. I would bargain that the value of a study like this is to help understand better the risks and incidence of viral transmission, and I doubt it was meant to be a way to justify non-condom sex -- that is a distinctly political goal.

It strikes me that if people can have their anxiety reduced about having sex with an infected partner because they know that the chances of infection are like other risks taken in life, then their relationship will be more positive. Of course stigma will also be reduced in the general population and that is always good.

Usually, any scientific study sets out to DISPROVE a hypothesis, and I would want to read what they were after in order to know better how to interpret their results.
« Last Edit: January 31, 2008, 08:30:12 AM by hartiepie »

Offline Tim Horn

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Re: "HIV-unprotected sex is possible" ?
« Reply #14 on: January 31, 2008, 09:28:03 AM »
Here's the "official" English translation of the Swiss Federal Commission for HIV/AIDS consensus statement.


HIV-infected persons on effective anti-retroviral therapy are sexually non-infectious 

P. Vernazza, B. Hirschel, E. Bernasconi


Summary
The Federal Commission for HIV/AIDS, following the proposal of the Sub-commission on Clinical and Therapeutic Aspects, and after review of the medical literature and extensive discussion, resolves that:
An HIV-infected person on anti-retroviral therapy with completely suppressed viremia („effective ART“) is not sexually infectious, i.e. cannot propagate HIV through sexual contact.

This statement is valid if
•   this person is compliant with ART, whose effect must be evaluated regularly by the treating physician, and
•   the viral load has been suppressed (non-detectable) since at least six months ago, and
•   there are no other sexually transmitted diseases

a)  Transmission depends on the viral load.
We define „effective ART“ as fully suppressive, stable treatment, with a viral load below the limits of detection in plasma (< 40 copies/ml).  Treatment is considered "stable" once the viral load has been undetectable for at least six months.  The Commission realizes that medical and biologic data available today do not permit proof that HIV-infection during effective ART is impossible, because the non-occurrence of an improbable event cannot be proven.  If no transmission events were observed among 100 couples followed for two years, for instance, there might still be some such events if 10'000 couples are followed for 10 years.  The situation is analogous to 1986, when the statement “HIV cannot be transmitted by kissing” was publicized.  This statement cannot be proven, but after 20 years’ experience its accuracy appears highly plausible.
Concerning the statement "an HIV-infected person on anti-retroviral therapy with completely suppressed viremia („effective ART“) cannot propagate HIV through sexual contact” however, the evidence is much better than what was available in 1986 regarding kissing.

     1) In sero-discordant couples (one person seropositive, the other seronegative), the risk of transmission depends on the viral load of the HIV-infected partner, see Figure 1 from reference (1).
     2) In a prospective study of 393 heterosexual sero-discordant couples there were no infections among partners of persons on ART, compared to a rate of transmission of 8.6% among partners of untreated patients (3).
     3) In another prospective study of 92 sero-discordant couples, where in 41 cases the HIV-positive partner had started therapy, there were 6 infections.  All these occurred in partners of untreated patients (3).
     4) Among 62 sero-discordant couples, where the male partner was HIV positive and on ART, with unprotected sex in order to conceive, there was no transmission (4).
     5) Transmission from mother to newborn also depends on the maternal viral load, and did not occur in pregnancies where the maternal viral load was below 1000 copies per ml.  If the maternal viral load is higher, transmission can be prevented by ART (5-8).

b) Effective ART eliminates virus from genital secretions
HIV-RNA, measured in sperm, declines below the limits of detection during ART (15-17).  The viral load (HIV-RNA) in female genital secretions is, as a rule, below the plasma VL and below the limits of detection during effective ART.  As a rule, it rises after, not before, an increase in plasma VL (18).  Cell-associated viral genomes are present in genital secretions, even during ART (15, 19-21).  But these are not functional virions.  HIV-containing cells in sperm lack markers of viral proliferations such as circular LTR-DNA (22).

The concentration of HIV RNA in sperm (sperm VL) correlates  with the risk of transmission.  Transmission risk declines towards 0 with falling sperm VL, see Figure 2.  These data indicate that the risk of transmission is greatly decreased by ART.

c) Exceptions and caveats
•   After a few days or weeks of discontinuation of ART, plasma viral load rises rapidly.  There is at least one case report of transmission during this rebound (14)
•   In patients without ART, sexually transmitted diseases (STDs, for instance urethritis or genital ulcer disease) increase the genital VL; it falls again after treatment of STD (24).  In a patient with urethritis, sperm VL can rise slightly even while patient is receiving effective ART.  This rise is small, however, much smaller that the rise observed in patients without ART.

d) Conclusion
•   During effective ART, free virus is absent from blood and genital secretions.  Epidemiologic and biologic data indicate that during such treatment, there is no relevant risk of transmission.
•   Residual risk can not be scientifically excluded, but is, in the judgment of the Commission, negligibly small

References
1   Quinn TC, Wawer MJ, Sewankambo N, et al. Viral load and heterosexual transmission of human immunodeficiency virus type 1. Rakai Project Study Group [see comments]. N Engl J Med 2000; 342: 921-929.
2   Castilla J, del Romero J, Hernando V, Marincovich B, Garcia S, Rodriguez C. Effectiveness of highly active antiretroviral therapy in reducing heterosexual transmission of HIV. J Acquir Immune Defic Syndr 2005; 40: 96-101.
3   Melo M, Varella I, Nielsen K, Turella L, Santos B. Demographic characteristics, sexual transmission and CD4 progression among heterosexual HIV-1 serodiscordant couples followed in Porto Alegre, Brazil. 16th International AIDS Conference, Toronto, 13-18.August 2006, TUPE0430. 2006.
4   Barreiro P, del Romero J, Leal M, et al. Natural pregnancies in HIV-serodiscordant couples receiving successful antiretroviral therapy. J Acquir Immune Defic Syndr 2006; 43: 324-326.
5   Garcia PM, Kalish LA, Pitt J, et al. Maternal Levels of Plasma Human Immunodeficiency Virus Type 1 RNA and the Risk of Perinatal Transmission. New England Journal of Medicine 1999; 431: 394-402.
6   Rousseau C, Nduati R, Richardson B, et al. Longitudinal analysis of human immunodeficiency virus type 1 RNA in breast milk and of its relationship to infant infection and maternal disease. J Infect Dis 2003; 187: 741-747.
7   Kilewo C, Karlsson K, Massawe A, et al. Prevention of mother-to-child transmission of HIV-1 through breastfeeding by treating mothers prophylactically with triple antiretroviral therapy in Dar es Salaam, Tanzania - the MITRA PLUS study. 4th IAS Conference, Sydney, July 2007 TUAX 101. 2007.
8   Arendt V. AMATA study: effectiveness of antiretroviral therapy in breastfeeding mothers to prevent post-natal vertical transmission in Rwanda. 4th IAS Conference, Sydney, July 2007 Abstract TUAX 102. 2007.
9   Porco TC, Martin JN, Page-Shafer KA, et al. Decline in HIV infectivity following the introduction of highly active antiretroviral therapy. AIDS 2004; 18: 81-88.
10   Yerly S, Vora S, Rizzardi P, et al. Acute HIV infection: impact on the spread of HIV and transmission of drug resistance. AIDS 2001; 15: 2287-2292.
11   Yerly S, Race E, Vora S, et al: HIV Drug Resistance and Molecular Epidemiology in Patients with Primary HIV Infection.  8th Conference on Retroviruses and Opportunistic Infections, Chicago, 4.-8.Feb.2001 2001; Abstract 754(Abstract)
12   Brenner BG, Roger M, Routy JP, et al. High rates of forward transmission events after acute/early HIV-1 infection. J Infect Dis 2007; 195: 951-959.
13   Chesson HW, Pinkerton SD. Sexually transmitted diseases and the increased risk for HIV transmission: implications for cost-effectiveness analyses of sexually transmitted disease prevention interventions. J Acquir Immune Defic Syndr 2000; 24: 48-56.
14   Bernasconi E, Vernazza PL, Bernasconi A, Hirschel B. HIV transmission after suspension of highly active antiretroviral therapy. J Acquir Immune Defic Syndr 2001; 27: 209.
15   Vernazza, P. L., Troiani, L., Flepp, M. J., Cone, R. W., Schock, J., Roth, F., Boggian, K., Cohen, M. S., Fiscus, S. A., Eron, J. J., and and the Swiss HIV Cohort Study. Potent antiretroviral treatment of HIV-infection results in suppression of the seminal shedding of HIV. AIDS.  2. 2000.
16   Cu-Uvin S, Caliendo AM, Reinert S, et al. Effect of highly active antiretroviral therapy on cervicovaginal HIV-1 RNA. AIDS 2000; 14: 415-421.
17   Vettore MV, Schechter M, Melo MF, Boechat LJ, Barroso PF. Genital HIV-1 viral load is correlated with blood plasma HIV-1 viral load in Brazilian women and is reduced by antiretroviral therapy. J Infect 2006; 52: 290-293.
18   Cu-Uvin S, Snyder B, Harwell JI, et al. Association between paired plasma and cervicovaginal lavage fluid HIV-1 RNA levels during 36 months. J Acquir Immune Defic Syndr 2006; 42: 584-587.
19   Vernazza PL, Kashuba DM, Cohen MS. Biological correlates of sexual transmission of HIV: practical consequences and potential targets for public health. Reviews in Medical Microbiology 2001; 12: 131-142.
20   Neely MN, Benning L, Xu J, et al. Cervical shedding of HIV-1 RNA among women with low levels of viremia while receiving highly active antiretroviral therapy. J Acquir Immune Defic Syndr 2007; 44: 38-42.
21   Kovacs A, Wasserman SS, Burns D, et al. Determinants of HIV-1 shedding in the genital tract of women. Lancet 2001; 358: 1593-1601.
22   Nunnari G, Otero M, Dornadula G, et al. Residual HIV-1 disease in seminal cells of HIV-1-infected men on suppressive HAART: latency without on-going cellular infections. AIDS 2002; 16: 39-45.
23   Chakraborty H, Sen P, Pranab K, et al. Viral burden in genital secretions determines male-to-female sexual transmission of HIV-1: a probabilistic empiric model. AIDS 2001; 15: 621-627.
24   Cohen MS, Hoffman IF, Royce RA, et al. Reduction of concentration of HIV-1 in semen after treatment of urethritis: implications for prevention of sexual transmission of HIV-1. Lancet 1997; 349: 1868-1873.
25   Sadiq ST, Taylor S, Kaye S, et al. The effects of antiretroviral therapy on HIV-1 RNA loads in seminal plasma in HIV-positive patients with and without urethritis. AIDS 2002; 16: 219-225.
26   Pilcher CD, Tien HC, Eron JJ, Jr., et al. Brief but Efficient: Acute HIV Infection and the Sexual Transmission of HIV. J Infect Dis 2004; 189: 1785-1792.

Offline RapidRod

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Re: "HIV-unprotected sex is possible" ?
« Reply #15 on: January 31, 2008, 10:02:47 AM »
The ole catch 22 statement.

Residual risk can not be scientifically excluded, but is, in the judgment of the Commission, negligibly small

Solution: USE A CONDOM

Offline Jacques

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Re: "HIV-unprotected sex is possible" ?
« Reply #16 on: January 31, 2008, 10:13:42 AM »
And if the condom breaks  ???

-------------------------------------------------------------------------------------------------------

Thanks Tim for posting the translation of the full text. I was looking for it but could not find.

---------------------------------------------------------------------------------------------------------
Quote from Hartiepie:
Quote
It strikes me that if people can have their anxiety reduced about having sex with an infected partner because they know that the chances of infection are like other risks taken in life, then their relationship will be more positive. Of course stigma will also be reduced in the general population and that is always good.


I fully agree with you Edfu.

Jacques
« Last Edit: January 31, 2008, 10:17:39 AM by Jacques »
Jacques
Living positively since 1987
latest lab :july 2010
Undetectable Cd4 1080
43% on Reyataz/Norvir/Truvada

Offline RapidRod

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Re: "HIV-unprotected sex is possible" ?
« Reply #17 on: January 31, 2008, 10:16:02 AM »
If the condom breaks, at least the person was protected up until the condom failed. That better than not using a condom at all.

Offline Jacques

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Re: "HIV-unprotected sex is possible" ?
« Reply #18 on: January 31, 2008, 10:23:16 AM »
and how about kissing ?  there is a neglectable chance of being infected but risk zero does'nt exist.  Should we stop kissing  ???

Jacques
Jacques
Living positively since 1987
latest lab :july 2010
Undetectable Cd4 1080
43% on Reyataz/Norvir/Truvada

Offline RapidRod

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Re: "HIV-unprotected sex is possible" ?
« Reply #19 on: January 31, 2008, 10:28:56 AM »
There has never been a document case of anyone contracting HIV by kissing.

Offline Tim Horn

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Re: "HIV-unprotected sex is possible" ?
« Reply #20 on: January 31, 2008, 10:35:19 AM »
and how about kissing ?  there is a neglectable chance of being infected but risk zero does'nt exist.  Should we stop kissing  ???

Jacques

This analogy was actually used by the Swiss Federal Commission on HIV/AIDS in its Bulletin of Swiss Medicine article announcing the consensus statement, according to an AIDSmap report posted yesterday:

The article begins by stating that the Commission “realises that medical and biologic data available today do not permit proof that HIV-infection during effective antiretroviral therapy is impossible, because the non-occurrence of an improbable event cannot be proven. If no transmission events were observed among 100 couples followed for two years, for instance, there might still be some such events if 10,000 couples are followed for ten years. The situation is analogous to 1986, when the statement ‘HIV cannot be transmitted by kissing’ was publicised. This statement has not been proven, but after 20 years’ experience its accuracy appears highly plausible.”

Tim Horn

Offline Jacques

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Re: "HIV-unprotected sex is possible" ?
« Reply #21 on: January 31, 2008, 10:44:07 AM »
Hey tanks  again Tim.

Could we  have your opinion about how we should deal with  this assertion from the Swiss commission  that transmission is unlikely to occur ?

Jacques
Jacques
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latest lab :july 2010
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Offline Tim Horn

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Re: "HIV-unprotected sex is possible" ?
« Reply #22 on: January 31, 2008, 12:00:33 PM »
Jacques:

The one major problem I have with this consensus statement is that it is based primarily on data from four studies involving heterosexual couples who, for the most part, were in exclusive relationships. While it's safe to assume that there was some "noise" in these studies -- the occassional couple practicing unprotected anal, not vaginal, sex and the occassional negative individual screwing around outside of the relationship -- I believe it's also reasonable to conclude that this was, perhaps, one of the easiest and most conservative populations to study (read: very little variability). My point here is that I don't know if we we can make general public health statements based on very distinct biological and behavioral factors involving a very specific population of individuals.

With that said, I do think that this consensus statement has a place in the grand scheme of "safer sex." This consensus statement -- and the research it is based on -- ultimately needs to be individualized. It would be naive to turn this into a simple black-and-white issue for everyone.

We all need to negotiate, whether it be with ourselves or our partners, what we consider to be risks we can and cannot live with. [Snip] No matter how much science is published... and no matter how many consensus statements are drafted... it is entirely up to us, as individuals, to decide which risks we are okay with. There's data and policy... but there's also common sense and communication. Most of us with HIV know damn well that the former should merely complement, not replace, the latter.

Just my two pennies,

Tim Horn 

Third paragraph edited -- I don't think it was making a relevant point. While I do think the association between viral load and infectivity is remarkable -- a biological factor I very much consider in my sexual relationship with my partner -- I just don't think we're at the point of being able to view this in such concrete terms, like HIV transmission and kissing. I think there's a need for additional studies that reflect the varying biologies and behaviors of people living with, and at risk for, HIV. Until then, I honestly believe that "HIV-infected persons on effective anti-retroviral therapy are sexually" less infectious. But "non-infectious?" I just don't think such cut-and-dry conclusions are possible.    
« Last Edit: January 31, 2008, 02:34:18 PM by Tim Horn »

Offline OneMoreGuy

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Re: "HIV-unprotected sex is possible" ?
« Reply #23 on: January 31, 2008, 12:22:02 PM »
I live in Switzerland and this was one of the major reported news articles today. Unfortunately, ALL articles made it sound more like HIV positive individuals whose current condition fell under the 3 points that were mentioned in the report could improve their quality of life by having unprotected sex.

I personally never felt that my 'quality of life' was hindered by the use of a condom, albeit I have had plenty of unprotected sex.

So, to me, being reported as it was, gives many a false sense of security and lulls them into thinking that as long as they follow these three points, all is okay and safe again.

Before this report came out, most doctors recommended that HIV patients on meds continued to practice safe sex, not only to avoid STDs, but to avoid being infected by different HIV strands which could harm the effectiveness of their current HIV meds as they could develop resistance. Now, the way it was reported in newspapers here today, it makes it sound as all is okay as long as the 3 points are followed.

At the end of the day, regardless of what the study has indicated, we all have to make our own choices of how we follow through with our sex life.

Studies are guidellines, but not specific licenses to stop us from thinking about what we are doing and stop us from taking responsibility for our own actions.

At best, the study gives couples where a partner is HIV a certain degree of hope if they have a desire to have children.

At worst, it provides an excuse, for those who need one, to have unprotected sex.
Psychologist, PhD
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Offline John2038

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Re: "HIV-unprotected sex is possible" ?
« Reply #24 on: January 31, 2008, 05:16:29 PM »
The ole catch 22 statement.

Residual risk can not be scientifically excluded, but is, in the judgment of the Commission, negligibly small

Solution: USE A CONDOM

Indeed RapidRod

Residual HIV-1 disease in seminal cells of HIV-1-infected men on suppressive HAART: latency without on-going cellular infections.

BASIC SCIENCE
AIDS. 16(1):39-45, January 4, 2002.
Nunnari, Giuseppe; Otero, Miguel; Dornadula, Geethanjali; Vanella, Michelle; Zhang, Hui; Frank, Ian a; Pomerantz, Roger J.

Abstract:
Background: HIV-1-infected men on suppressive highly active antiretroviral therapy (HAART) have a reduction of viral replication in vivo, but HIV-1 RNA is still detectable by certain ultrasensitive reverse transcriptase-PCR assays in blood plasma. Replication-competent virus can also be isolated from both peripheral blood mononuclear cells (PBMC) and seminal cells of these patients. Despite HAART, on-going in vivo infection of HIV-1-seropositive patients' PBMC was demonstrated by the detection of episomal HIV-1 moieties, known as HIV-1 two-long terminal repeat (2-LTR) DNA circles.

Methods: The present study analyzes whether new cellular infections occur in vivo in seminal cells of HIV-1-infected men on suppressive HAART. PBMC and seminal cells were isolated from a cohort of HIV-1-seropositive men taking suppressive HAART (< 50 copies HIV RNA/ml blood plasma). Viral growth assays were performed in vitro, as well as semi-quantitative PCR to detect HIV-1 2-LTR circular DNA in PBMC and seminal mononuclear cells.

Results: Viral growth in vitro was demonstrated in 16 out of 28 (57%) patients' PBMC, and in five patients' seminal cells (18%). Although 18 patients' PBMC were positive for HIV-1 2-LTR DNA circles, importantly, 2-LTR circular DNA was not detected in any semen sample, even when replication-competent HIV-1 virus had been recovered from a patient's seminal cells by viral co-culture assays.

Conclusions: The current study suggests that in HIV-1-infected men treated with suppressive HAART, new cellular infections occur in PBMC, but that new infections do not take place in seminal cells in vivo. Thus, these findings suggest that mainly latent HIV-1 occurs in seminal cells of men on suppressive HAART, which may be a compartment-specific mechanism of residual HIV-1 disease.

(C) 2002 Lippincott Williams & Wilkins, Inc.


Now, this study did not make any assumptions reagarding the patients (kind of relationship, how long time on effective HAART, treatment, adherence, presence of IST, etc), what the Swiss report does.

As such, the conclusions might be still in favor of the swiss conclusions.
Of course, it's a choice that both partners have to do.
But you right, risk epsilon still means risk not null. But comparable to any common risk in the life, if not less no ?

Probably, sex with condom is still an option (to reach the risk 0),  but not necessarily just after an undetectable lab, if the criteria of the swiss report are met. If so, a new expression is born "condom holidays" no ?


NOTE
Accordingly to Pr. Bernard Hirshel, the 2 only cases reported where the virus was detectable in the sperm was for 2 patients (among 114 - St. Gall study) under HAART since 8 weeks (instead of 6 months) and under:
- stavudine, saquinavir and ritonavir for one one the two
- didanosine, stavudine and hydroxyura for the others.
Both treatments are now considered as unconventional (not recommended in the treatment guidelines 2007)

EDIT: Font
« Last Edit: January 31, 2008, 05:39:43 PM by John2038 »

Offline ajm_ldn

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Re: "HIV-unprotected sex is possible" ?
« Reply #25 on: January 31, 2008, 05:39:33 PM »

http://www.aidsmap.com/en/news/4E9D555B-18FB-4D56-B912-2C28AFCCD36B.asp


Swiss HIV experts have produced the first-ever consensus statement to say that HIV-positive individuals on effective antiretroviral therapy and without sexually transmitted infections (STIs) are sexually non-infectious. The statement is published in this week’s Bulletin of Swiss Medicine (Bulletin des médecins suisses). The statement also discusses the implications for doctors; for HIV-positive people; for HIV prevention; and the legal system.

The statement, on behalf of the Swiss Federal Commission for HIV / AIDS was authored by four of Switzerland’s foremost HIV experts: Prof Pietro Vernazza, of the Cantonal Hospital in St. Gallen, and President of the Swiss Federal Commission for HIV / AIDS; Prof Bernard Hirschel from Geneva University Hospital; Dr Enos Bernasconi of the Lugano Regional Hospital; and Dr Markus Flepp, president of the Swiss Federal Office of Public Health’s Sub-committee on the clincal and therapeutic aspects of HIV / AIDS.

The statement’s headline statement says that “after review of the medical literature and extensive discussion,” the Swiss Federal Commission for HIV / AIDS resolves that, “An HIV-infected person on antiretroviral therapy with completely suppressed viraemia (“effective ART”) is not sexually infectious, i.e. cannot transmit HIV through sexual contact.”

It goes on to say that this statement is valid as long as:

the person adheres to antiretroviral therapy, the effects of which must be evaluated regularly by the treating physician, and


the viral load has been suppressed (< 40 copies/ml) for at least six months, and


there are no other sexually transmitted infections.


The article begins by stating that the Commission “realises that medical and biologic data available today do not permit proof that HIV-infection during effective antiretroviral therapy is impossible, because the non-occurrence of an improbable event cannot be proven. If no transmission events were observed among 100 couples followed for two years, for instance, there might still be some such events if 10,000 couples are followed for ten years. The situation is analogous to 1986, when the statement ‘HIV cannot be transmitted by kissing’ was publicised. This statement has not been proven, but after 20 years’ experience its accuracy appears highly plausible.”

It then states that the evidence for the Commission’s current assertion about the relationship between treatment and sexual HIV transmisson is much more informed than what was available in 1986 regarding the transmission of HIV through kissing.

For example, they note, Quinn and colleagues found that in sero-discordant couples the risk of transmission depended on the viral load of the HIV-positive partner, and refer also to a prospective study of 393 heterosexual sero-discordant couples from Castilla and colleagues found that there were no infections among partners of persons on antiretroviral therapy, compared to a rate of transmission of 8.6% among partners of untreated patients. They also note that transmission from mother to newborn also depends on the maternal viral load, and can be avoided by taking antiretroviral therapy.

They go on to assert that effective antiretroviral therapy eliminates HIV from genital secretions. They say that HIV RNA, measured in sperm, declines below the limits of detection on antiretroviral therapy, and that HIV RNA is also below the limits of female genital secretions is, as a rule, during effective antiretroviral therapy. “As a rule,” they write, “it rises after, not before, an increase in plasma viral load.”

They also assert that although cell-associated viral genomes are present in genital secretions, even on antiretroviral therapy, these are not infectious virions since “HIV-containing cells in sperm lack markers of viral proliferations such as circular LTR-DNA.”

They note that the concentration of HIV RNA in sperm correlates with the risk of transmission and that “transmission risk declines towards zero with falling sperm viral load. These data indicate that the risk of transmission is greatly decreased by antiretroviral therapy.”

They add, however, several exceptions and caveats to the above statements:

After a few days or weeks of discontinuation of antiretroviral therapy, plasma viral load rises rapidly. There is at least one case report of transmission during this rebound.


In patients not on treatment, STIs such as urethritis or genital ulcer disease increase the genital viral load; it falls again after the STI is treated.


In a patient with urethritis, sperm viral load can rise slightly even while the patient is receiving effective treatment. This rise is small, however, much smaller that the rise observed in patients not on treatment.

They conclude the scientific part of the article by saying that: “During effective antiretroviral therapy, free virus is absent from blood and genital secretions. Epidemiologic and biologic data indicate that during such treatment, there is no relevant risk of transmission. Residual risk can not be scientifically excluded, but is, in the judgment of the Commission, negligibly small.”

Implications for doctors

The Commission then discusses the implications for doctor-patient discussions. It says, "the following information aims to communicate to doctors criteria allowing them to establish whether or not a patient can sexually transmit HIV.
HIV cannot be transmitted sexually if:

The HIV-positive individual takes antiretroviral therapy consistently and as prescribed and is regularly followed by his/her doctor.


Viral load is ‘undetectable’ and has been so for at least six months


The HIV-positive individual does not have any STIs."


Implications for HIV-positive people

The Commission states that an HIV-positive person in a stable relationship with an HIV-negative partner, who follows their antiretroviral treatment consistently and as prescribed and who does not have an STI, is "not putting their partner at risk of transmission by sexual contact."

"Couples must understand," they write, "that adherence will become omnipresent in their relationship when they decide not to use protection, and due to the importance of STIs, rules must be defined for sexual contacts outside of relationship."

"The same goes for people who are not in a stable relationship," they add. However due to the importance of STIs, use of condoms is still recommended.

They add that heterosexual women will have to consider eventual interactions between contraceptives and antiretrovirals before considering stopping using condoms.

They also say that insemination via sperm washing is no longer indicated when "antiretroviral treatment is efficient."

Implications for HIV prevention

The Commission says that it "is not for the time being, considering recommendations that HIV-positive individuals start treatment purely for preventative measures." Aside from the cost involved, they argue, it cannot be certain that HIV-positive people would be sufficiently motivated to follow, and apply to the letter, antiretroviral treatment on a long-term basis without medical indications. They note that poor adherence is likely to facilitate the development of resistance, and that, therefore, antiretroviral therapy as prevention is indicated only in "exceptional circumstances for extremely motivated patients."

The Commission also says that their statement should not change prevention strategies currently taking place in Switzerland. With the exception of stable HIV-positive couples where HIV-positivity and the efficacy of antiretroviral therapy can be established, measures to protect oneself must be followed at all times. "People who are not in a stable relationship must protect themselves," they note, "as they would not be able to verify whether their partner is positive or on efficient antiretroviral therapy."

Implications for the legal system

Finally, the Commission says that courts will have to take into account the fact that HIV-positive people on antiretroviral treatment and without an STI cannot transmit HIV sexually in criminal HIV exposure and transmission cases.

They conclude by stating that the Commission thinks that unprotected sex between a positive person on antiretroviral treatment and without an STI, and an HIV-negative person, does not comply with the criteria for an “attempt at propagation of a dangerous disease” according to section 231 of the Swiss penal code nor for “an attempt to engender grievous bodily harm” according to section122, 123 or 125.

Reference
Vernazza P et al. Les personnes séropositives ne souffrant d’aucune autre MST et suivant un traitment antirétroviral efficace ne transmettent pas le VIH par voie sexuelle. Bulletin des médecins suisses 89 (5), 2008.

Offline edfu

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Re: "HIV-unprotected sex is possible" ?
« Reply #26 on: January 31, 2008, 07:57:01 PM »
From the Associated Press:

"Not only is (the Swiss proposal) dangerous, it's misleading and it is not considering the implications of the biological facts involved with HIV transmission," said Jay Levy, director of the Laboratory for Tumor and AIDS Virus Research at the University of California in San Francisco.
"No one will ever be free so long as there are pestilences."--Albert Camus, "The Plague"

"Mankind can never be free until the last brick in the last church falls on the head of the last priest."--Voltaire

Offline Jacques

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Re: "HIV-unprotected sex is possible" ?
« Reply #27 on: January 31, 2008, 09:59:43 PM »
Quote
it is not considering the implications of the biological facts involved with HIV transmission

Well, I'd be interested in knowing more about the implications of those biological facts being involved.

Edfu, could you provide some more  complete information about Dr Levy's position ?

Jacques 
Jacques
Living positively since 1987
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Offline edfu

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Re: "HIV-unprotected sex is possible" ?
« Reply #28 on: January 31, 2008, 11:31:54 PM »
Levy said there was no safe way of knowing whether a patient with HIV who has no detectable virus in the blood will not transmit the virus. More research into the links between viral load in the blood and the presence of the virus in genital fluid was needed, he said.
"No one will ever be free so long as there are pestilences."--Albert Camus, "The Plague"

"Mankind can never be free until the last brick in the last church falls on the head of the last priest."--Voltaire

Offline otherplaces

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Re: "HIV-unprotected sex is possible" ?
« Reply #29 on: February 01, 2008, 12:06:58 AM »

I believe in the presence of effective treatment, and as treatment becomes more and more effective and stable we will find that the evidence mounts on the side of the Swiss.

I think the main implications are for couples who want to lose the condom to attempt to conceive a baby.  The science points in the direction that it might actually be of little to no risk if the poz person is on effective therapy, and they may decide it's worth the minor to nil risk.  It's their informed decision to make.

What I get out of this is that if I ever do end up in a relationship with a neg woman not only can I count on condoms being effective, but also a 2nd tier of effective therapy essentially as a 2nd line of defense.  I would feel much better that as you stack solid prevention on top of solid prevention one can relax and actually love someone and not worry so much about the HIV problem.  It'd be nice to not have to put all your eggs in once basket.

Perhaps a good analogy would be women on birth control who also make their men wear a condom.  With two lines of defense ain't no babies goin' to be made for sure.



Offline DCGUY2007

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Re: "HIV-unprotected sex is possible" ?
« Reply #30 on: February 01, 2008, 03:16:20 AM »
I have read the Swiss article and agree with Doktors early comments which I posted at the bottom of this email again.

Also I only had unprotected sex once in my life never used drugs and became poz. I understand this article is about heterosexual couples and the persons viral load being very low but still other factors do come into play. Some people are more susceptible to an illness than others. One person can smoke eat a lot of fat and live a long life another can eat healthy exercise and die early from cancer. I think clinical studies will find in the future that there is a lot more to catching HIV than just viral loads,tcell counts and unprotected sex.


"No matter what new findings about HIV transmission come to light, one cannot loose sight that we are not all created equal. Some people are more susceptible to get infected quicker than others. Sometimes it has to do with how strong our immune system is at any given point.

As with anything in life, we have to take responsibility for what we decide to do and not look to blame any negative outcomes for our actions based on what someone else said." (Doktor's quote)


Offline komnaes

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Re: "HIV-unprotected sex is possible" ?
« Reply #31 on: February 01, 2008, 04:36:30 AM »
This is interesting that the report came around the same time that the health authority in Taiwan is recommending folks to use condoms even for oral sex. Confusing..

I do agree with Otherplaces above me - it should make those have undetectable viral load to ease some of the anxiety while their partners are negative. Condoms will still be used carefully but knowing that the chance of getting infected by someone who's on effective treatments will help a lot of them (and also their partners)  in relaxing a bit.

Otherwise, for those who are lucky to still be on the other side.. use condoms..

Shaun
Aug 07 Diagnosed
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Offline John2038

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Re: "HIV-unprotected sex is possible" ?
« Reply #32 on: February 01, 2008, 10:30:50 AM »
At the end, this report contains the conclusions of :

- a study of including 393 heterosexual couples
- the analysis of all the available related studies

So the conclusions are based on evidences.

These conclusion is really a great news.
It gives the confirmation that being poz and having a normal life is possible.
It allows to more s- to more easily consider having a long term relationships with a s+, without having too fear so much.
It make this disease less awfull, give us energy, and hops.

The problem is about a virologic failure. But having a condom holiday in the weeks following the last undetectable lab should be very reasonable. These Swiss renewed doctors have the know how and the expertise to publish such reports.

Why not just accept it as such ?

Offline Iggy

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Re: "HIV-unprotected sex is possible" ?
« Reply #33 on: February 01, 2008, 11:31:46 AM »
- the analysis of all the available related studies

I didn't see that myself.  Am I missing something?


It gives the confirmation that being poz and having a normal life is possible.
It allows to more s- to more easily consider having a long term relationships with a s+, without having too fear so much.
It make this disease less awfull, give us energy, and hops.

I don't see it as doing those things at all.  I'm glad that this encourages you and I find very interesting findings that are worth exploring in this study, but I think you are reaching with these three above listed statements.

Offline Jacques

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Re: "HIV-unprotected sex is possible" ?
« Reply #34 on: February 01, 2008, 11:52:23 AM »
Quote
- the analysis of all the available related studies

Iggy

I think that John was referring to that statement:

Quote
The statement’s headline statement says that “after review of the medical literature and extensive discussion,”


Jacques
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Offline John2038

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Re: "HIV-unprotected sex is possible" ?
« Reply #35 on: February 01, 2008, 11:58:53 AM »
I didn't see that myself.  Am I missing something?

Yes, but it's not published in this thread.  ;)

While talking about the cases of infections while undetectable, Pr Hirshel says:

Despite major efforts, we found no cases published in the medical literature [of HIV infections while undetectable], which contains over 100,000 articles and books about HIV.

Source: http://papamamanbebe.net/a8203-viremie-et-contamination-bernard-hirschel-d.html

I don't see it as doing those things at all.  I'm glad that this encourages you and I find very interesting findings that are worth exploring in this study, but I think you are reaching with these three above listed statements.

No. It's just a consequence of :
These Swiss renewed doctors have the know how and the expertise to publish such reports.

I believe that publishing such reports is not something you do without a very high degree of certainty.
I also believe that there is still a risk, but that this risk is comparable to any others in the life.
Do we stop driving car ? Finally, I say that this is a great news. A fantastic news. Up to both partners now to decide: risk 0 or epsilon. At least, we know now that the risk is epsilon (0.0..1%), and not let say 10%.

Offline Iggy

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Re: "HIV-unprotected sex is possible" ?
« Reply #36 on: February 01, 2008, 12:16:16 PM »
John,

I'm gonna admit I am dense on this point, but after reading this thread it seemed that the point of Pr Hirshel point was sort of negated as the central focus of their research and report was on hetero (and I believe monogamous) couples.

If that is correct, I think there is a danger in extrapolating these results into a larger statement.

Offline hartiepie

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Re: "HIV-unprotected sex is possible" ?
« Reply #37 on: February 01, 2008, 12:36:15 PM »
When generalizing the results to a larger population, that target group should match the study group. Here it would be those folks listed quite plainly in the study (heterosexual, monogamous, VL undetectable etc).

However, it would not be much of a stretch to predict that gay couples with the same criteria would experience similar if not identical results. Of course, throwing in other variables like STD history, non-monogamy etc would negate generalization.

Another value of a meta-analysis like this is to encourage research for groups that are different from the studies' participants -- primarily gay men. If it worked for this identified group, will it work for another? Can't be strongly discussed without data.........

Offline John2038

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Re: "HIV-unprotected sex is possible" ?
« Reply #38 on: February 01, 2008, 12:36:56 PM »
..their research and report was on hetero (and I believe monogamous) couples.

If that is correct, I think there is a danger in extrapolating these results into a larger statement.

You are absolutely right. Sorry for the misunderstanding, but it was assumed (in my mind) as the details of this research have been discussed previously. The research have to be pursued for the others ocouple couples.

Interview in english of Pr Hirshel

Patients treated for HIV, with undetectable viremia, are no longer infectious: arguments for and against

http://papamamanbebe.net/a8205-patients-treated-for-hiv-with-undetectable.html


Offline redhotmuslbear

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Re: "HIV-unprotected sex is possible" ?
« Reply #39 on: February 01, 2008, 12:47:55 PM »
I believe that publishing such reports is not something you do without a very high degree of certainty.  I also believe that there is still a risk, but that this risk is comparable to any others in the life.  Do we stop driving car ? Finally, I say that this is a great news. A fantastic news. Up to both partners now to decide: risk 0 or epsilon. At least, we know now that the risk is epsilon (0.0..1%), and not let say 10%.


Despite the enthusiasm of over this study, there are many dangers surrounding it which need to be considered:

1.  The study population was exclusively heterosexual with vaginal penetration.  Queermen and others who enjoy anal penetration cannot rely on the outcomes.

2.  Our viral loads are valid only at the time of sampling and only for blood, as others have pointed out.  We know from collective experience that spikes in viral load occur, even during periods below the threshold of detection, seemingly without notice.  Without spot viral load testing immediately prior to intercourse, the reduced risk cannot be guaranteed.

3.  Other STIs are as much a threat to the HIV+ partner, as HIV could be to the negative partner.



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Offline John2038

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Re: "HIV-unprotected sex is possible" ?
« Reply #40 on: February 01, 2008, 01:46:26 PM »
Despite the enthusiasm of over this study, there are many dangers surrounding it which need to be considered:

1.  The study population was exclusively heterosexual with vaginal penetration.  Queermen and others who enjoy anal penetration cannot rely on the outcomes.

2.  Our viral loads are valid only at the time of sampling and only for blood, as others have pointed out.  We know from collective experience that spikes in viral load occur, even during periods below the threshold of detection, seemingly without notice.  Without spot viral load testing immediately prior to intercourse, the reduced risk cannot be guaranteed.

3.  Other STIs are as much a threat to the HIV+ partner, as HIV could be to the negative partner.

Sorry to come back to argue a bit again, but here is a small summary:

a) The thesis of Pr. Hirschel is to say:

For the couple that are:
hetero - monogamy - stable relationship

if the viral load of HIV in the blood of a the s+ is undetectable for more than 6 months, he can not infect (risk epsilon) his partner during unprotected sexuals intercourses.

3 conditions have to be met:

1- No virus has been detected in the patient's blood for six months
2- The treatment is regularly monitored and controlled
3- The patient have no other sexually transmitted disease.

b) A number of publications exists, which goes in this direction, some of them indicating 1000 cp/ml the threshold below which the infection would be "impossible".

Personal assumptions

A blip is still possible, but the risk of infection is still very low. Why ? It's about stats..
If you are undetectable for 6 months, then probability to potentially infect your partner is not the same as if you have just started your treatments (see studies below). In others words, the risk at 6m + x is lower than at 2m + y (where x and y are months).
Of course, the more x increase, the more the risk increase. But this risk is minimized by a regular follow-up of the doctor, who may offer to have protected sex again.

Studies

1) The recent study of P. Vernazza in St. Gallen [3], shows detectable virus in semen of 2 of 114 patients with undetectable viral load in the blood.
And the two exceptions are instructive: The first was treated for only 8 weeks with a combination of stavudine, saquinavir, and ritonavir, and the second with didanosine, stavudine and hydroxyurea. Both cases were not treated long enough, and both received unconventional treatment which would not qualify as effective HAART in 2007

2) Despite major efforts, the research team haven't found any cases published in the medical literature (over 100,000 articles and books about HIV parsed) of an HIV infections while undetectable. This literature and books include .

The two images below summarize the conclusions of the Swiss doctors.

i) Viral load and risk of infection


ii) Viral load in the sperm and risk of infection


About the s+ having unstable relationships

The same apply for them.

Source (french): http://papamamanbebe.net/a8238-les-personnes-seropositives-ne-souffrant-d-a.html

The spirit of the study
a) Inform people (s+/s-) having a stable relationship, that the s+ partner do not put his partners at risk as long as long as the 3 criteria above are met. Not put at risk meaning no more risks than any other events that each of us are daily exposed (e.g. car accident).
b) It is up to the s- to take the final decision.
c) This announce may help those willing to have babies to have them in a natural way.

So it's just about informing, and letting people decide.

It's a hard decision but it's good to know.
At least, in case of condom failure.

Hops this help.
« Last Edit: February 01, 2008, 01:51:50 PM by John2038 »

Offline redhotmuslbear

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Re: "HIV-unprotected sex is possible" ?
« Reply #41 on: February 01, 2008, 02:42:18 PM »
Sorry to come back to argue a bit again, but here is a small summary:  <<deleted for space>>
So it's just about informing, and letting people decide.
It's a hard decision but it's good to know.
At least, in case of condom failure.
Hops this help.

John,
A "small summary" does not include big-ass graphics.  ;)

Sure, people can decide for themselves, and they have always had that freedom and the information available for taking choices.  The biggest problem surrounding the frenzy over this "announcement" is that people rely on dated and unreliable personal health information all too often as-is, such as in supposed neg-on-neg unprotected anal intercourse that leads to sero-conversion.  Nightmarish visions of people avoiding routine labs so they can live in an "undetectable world of sex" come to mind, though they aren't far-fetched with people avoiding base HIV testing to keep from knowing they are HIV+ (I did that for 15+ years!).  Compound that with the fact that many of us with HIV are not in sexually-exclusive couples, if coupled at all.  Put humpin' around together with bad facts, and we've got continued proliferation of this damned virus, not less.

Mind you, I am not sex-negative or pro-sexual exclusivity (ha!), but if one is going to attempt to argue "stats," one must look at a much larger picture and consider the ramifications of human behavior, not just theory. 

Cheers,
David
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Offline hartiepie

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Re: "HIV-unprotected sex is possible" ?
« Reply #42 on: February 01, 2008, 05:12:22 PM »
Quote
but if one is going to attempt to argue "stats," one must look at a much larger picture and consider the ramifications of human behavior, not just theory.
 
True.......but the stats are just numbers and say nothing in and of themselves. People interpret them and they have the responsibility to find out what they are reading, and about how those numbers were calculated.

Hence this discussion.
« Last Edit: February 01, 2008, 05:18:57 PM by hartiepie »

Offline edfu

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Re: "HIV-unprotected sex is possible" ?
« Reply #43 on: February 03, 2008, 07:37:54 AM »
I just found this study, published before the Swiss one, which seems to directly contradict several of the Swiss findings.  Undetectable viral load does not equal zero infection risk:

http://www.aidsmap.com/en/news/167784F9-FD3C-4148-8AB3-F669FE941BB3.asp
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Offline hartiepie

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Re: "HIV-unprotected sex is possible" ?
« Reply #44 on: February 03, 2008, 08:01:20 AM »
Quote
I just found this study, published before the Swiss one, which seems to directly contradict several of the Swiss findings.  Undetectable viral load does not equal zero infection risk:

Just to be clear, the Swiss study does not state a zero risk. Even condom proponents could honestly not make such a claim.........

This report does not contradict the Swiss findings at all since they are talking about two different things. Namely, in one it is the incidence of transmission in hetero couples, and and the other is about the occurrence of virus in semen.

You are right in that they do have different recommendations, however.
« Last Edit: February 03, 2008, 08:10:09 AM by hartiepie »

Offline Ann

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Re: "HIV-unprotected sex is possible" ?
« Reply #45 on: February 03, 2008, 11:00:13 AM »
Even condom proponents could honestly not make such a claim.........


As long as the condom remains intact, we can.

A properly used condom RARELY breaks. Read all three condom and lube links... yada yada yada!

Ann
« Last Edit: February 03, 2008, 11:06:48 AM by Ann »
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Offline hartiepie

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Re: "HIV-unprotected sex is possible" ?
« Reply #46 on: February 03, 2008, 01:04:46 PM »
Ann: You are right. People can and do claim any number of things. But in statistical talk, there is no 100 percent certainty.

Not looking for an argument here--- just sayin'..........

Offline Queen Tokelove

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Re: "HIV-unprotected sex is possible" ?
« Reply #47 on: February 03, 2008, 01:45:32 PM »
Interesting topic this is.....There was enough medical jargon to make my eyes cross.... :D It would be nice if someone could just break it all down in plain layman's terms so those of us who can't make head or tails of it all could really make responsible decision. Bottom lining it all, it really comes down to the individual.
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Offline Jacques

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Re: "HIV-unprotected sex is possible" ?
« Reply #48 on: February 03, 2008, 02:29:32 PM »
Quote
A properly used condom RARELY breaks

Ann, rarely is not zero.

Jacques
Jacques
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Offline RapidRod

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Re: "HIV-unprotected sex is possible" ?
« Reply #49 on: February 03, 2008, 02:36:34 PM »
Ann, rarely is not zero.

Jacques

A lot safer than not using a condom at all.

 


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