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Author Topic: "HIV-unprotected sex is possible" ?  (Read 28044 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
Living positively since 1987
latest lab :july 2010
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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
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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.

Offline Dachshund

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Re: "HIV-unprotected sex is possible" ?
« Reply #50 on: February 03, 2008, 03:19:26 PM »
Ann, rarely is not zero.

Jacques

Oh really Jacques? Rarely is not zero? Wow, thanks for that erudite clarification. C'mon Ann, the Greek chorus demands a retraction. However, we can say that a condom that remains intact does not break.

Offline hartiepie

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Re: "HIV-unprotected sex is possible" ?
« Reply #51 on: February 03, 2008, 04:06:10 PM »
Jacques is correct: Rarely = not zero. Why needle him? It isn't advancing any information here to do so.

Offline Dachshund

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Re: "HIV-unprotected sex is possible" ?
« Reply #52 on: February 03, 2008, 04:18:37 PM »
Jacques is correct: Rarely = not zero. Why needle him? It isn't advancing any information here to do so.

It isn't advancing anything to point out the obvious. Not looking for any argument here, just sayin...

Offline Cerrid

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Re: "HIV-unprotected sex is possible" ?
« Reply #53 on: February 04, 2008, 12:21:44 PM »
I just found this study, published before the Swiss one, which seems to directly contradict several of the Swiss findings. 
http://www.aidsmap.com/en/news/167784F9-FD3C-4148-8AB3-F669FE941BB3.asp

Thank you for pointing this out, because this study doesn't contradict the Swiss statement, it strengthens it. In the study you quoted, the investigators  stress, "in fact, the studies with the lowest correlations between blood plasma viral load and semen viral load are those that are most likely to have included men with co-occurring sexually transmitted infections."

That's why the Swiss researchers put special emphasis on the subject of STD. If there are STD present, one of their three criteria for unprotected sex isn't met.

The authors of the quoted study also state: "Poor adherence to anti-HIV therapy was associated with detectable HIV in semen in some studies, and another study showed that the men who missed the fewest treatment doses had the greatest degree of HIV suppression in semen over time. The same is true for adherence."

That's another point the Swiss researchers put into account: If there's poor adherence, another one of the three crucial criteria for unprotected sex isn't fulfilled.

Only if all three conditions are met, it's safe. Or as the Swiss say: the risk is negligible. Don't forget there has never been a single documented case where someone who's on meds has infected his or her partner, gays and straights included. So that's a most negligible risk. Even the study authors you quoted don't present such a transmission case. They talk about virus concentrations and theoretical risks, which is a totally different pair of boots.

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.

Lemme try...

If you're taking meds, then there are three conditions which have to be met to rule out transmission. The Swiss docs make it pretty clear where the limits are, and these limits are totally based upon your medical situation - no matter if you're a boy or a girl, gay or straight, young or old. If there are STDs present, you should use a condom. If your VL is detectable, use a condom. If your VL has been undectectable for less than six months in a row, use a condom. If you're not adherent, use a condom.

If you fulfill the criteria, but feel uncomfortable with the situation and still fear a risk, use a condom. It's your decision. But now you have a choice!

Hope this helps! ;)
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Offline RapidRod

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Re: "HIV-unprotected sex is possible" ?
« Reply #54 on: February 04, 2008, 12:30:16 PM »
I don't know anyone in their right mind that would even take a chance of having unprotected sex with anyone that is known to be HIV positive when they are negative. I can't fathom anyone taking that chance.

Offline hartiepie

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Re: "HIV-unprotected sex is possible" ?
« Reply #55 on: February 04, 2008, 12:35:41 PM »
Quote
I don't know anyone in their right mind that would even take a chance of having unprotected sex with anyone that is known to be HIV positive when they are negative. I can't fathom anyone taking that chance.


The studies are full of them. That's how they got the data.

Just for the record, I advocate condoms.

Offline John2038

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Re: "HIV-unprotected sex is possible" ?
« Reply #56 on: February 04, 2008, 12:53:29 PM »
I don't know anyone in their right mind that would even take a chance of having unprotected sex with anyone that is known to be HIV positive when they are negative. I can't fathom anyone taking that chance.

I will (sorry) only to have babies (and the partner have something to say of course, and my doctor as well).
And if otherwise the condom break, then its good to know that the risk of infection is epsilon.

I also believe that the risk is more psychological than real (see graphs and studies).

This study is also interesting if we try to translate it to a POZ/POZ relationships (assumption!):

Between 2 POZ, undetectable since at least 6 months, having no STDs and being 100% adherent, the risk of super infection is epsilon. Do you feel the epsilon now ?  ;)
« Last Edit: February 04, 2008, 01:23:06 PM by John2038 »

Offline Teresa

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Re: "HIV-unprotected sex is possible" ?
« Reply #57 on: February 04, 2008, 12:57:10 PM »
As the negative half in a poz/neg relationship, there is NO way I would have sex without a condom.

I guess according to this article that if the condom was to break I wouldn't be at so much of a risk as I thought I would be. That would be some peace of mind, I suppose, but i would still call the Dr and see what she thought.

Like others have said its just up to the individual as to how much of a risk you are willing to take. For me its using condoms each and every time.


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Offline Iggy

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Re: "HIV-unprotected sex is possible" ?
« Reply #58 on: February 04, 2008, 01:51:06 PM »
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



John,

You are kind of funny with this.  You  admitted that my point (that this study is selective and that you can't make such broad statements) and then in the same breath you repeat the falsity as declared in the headline of that report.

The bottom line is that the study is but one group's findings on a select population that needs to be explored and not tooted as a definite statement of HIV in general.

Did it ever occur to you that continued promotion of this study without the context of the broader truth is very similar to certain AIDS Denalists statements?  They have a habit of taking non representative findings out of context too.


Offline John2038

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Re: "HIV-unprotected sex is possible" ?
« Reply #59 on: February 04, 2008, 01:57:45 PM »
Nice try Iggy.

Initial post:


HIV: unprotected sex are possible

..
This is the conclusion of a study of 393 heterosexual couples in which one partner is infected.

Three conditions must be met for the virus to not be transmitted through sexual contact.

Offline Iggy

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Re: "HIV-unprotected sex is possible" ?
« Reply #60 on: February 04, 2008, 02:06:18 PM »
John,

When I brought up this:


Quote
Quote from: John2038 on 01 February 2008, 10:30:50

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.

your response was:
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

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%.

How am I making a nice try?  I said in the beginning and I repeat again - you making broad statements such as these based off of misleading data that does not have the full support of the scientific community (at least other studies that significantly back up this point) is misleading and it is damaging to real prevention efforts.

Offline John2038

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Re: "HIV-unprotected sex is possible" ?
« Reply #61 on: February 04, 2008, 02:12:22 PM »
I have nothing to respond, your interpretation is biased.  ;)

Offline Iggy

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Re: "HIV-unprotected sex is possible" ?
« Reply #62 on: February 04, 2008, 02:13:16 PM »
I have nothing to respond, your interpretation is biased.  ;)

I see...

Offline edfu

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Re: "HIV-unprotected sex is possible" ?
« Reply #63 on: February 05, 2008, 03:00:29 AM »
Cerrid,

I can selectively quote as well as you to prove that the January 2008 study does indeed contradict the Swiss study.  For example:

"Prevention messages should stress the importance of condoms and other risk reduction strategies, regardless of whether a patient is taking effective anti-HIV therapy, recommend the investigators, as HIV transmission is possible even if a patient has an undetectable viral load in their semen....

"Most of the studies showed that anti-HIV therapy suppressed viral load in semen. But there was also evidence that some anti-HIV drugs did not penetrate the blood and semen with equal efficiency. But in ideal conditions, when men were taking an effective antiretroviral regimen, were fully adherent to their therapy, and did not have a sexually transmitted infection, then there was a 95% certainty that below 4% of men with an undetectable viral load in their blood would have a detectable viral load in their semen. However, the investigators note, 'these optimal conditions are rarely met outside of research settings.'...

"Men who are treated with anti-HIV therapy can develop drug-resistant virus in their semen, and there is evidence of multi-drug resistant strains of HIV developing in the genital tract but not blood....

"Furthermore, the investigators note that semen that has an undetectable viral load is still potentially infectious, and that cells in semen can contain HIV proviral DNA and can act 'as vehicles for sexual transmission of HIV.'...

"The investigators recommend that 'HIV prevention messages targeted to both infected and uninfected persons should communicate the importance of condoms and other risk reduction strategies regardless of HIV treatment status and at all stages of HIV disease....'"



 




"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 edfu

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Re: "HIV-unprotected sex is possible" ?
« Reply #64 on: February 05, 2008, 03:10:47 AM »
UNAIDS and the World Health Organization respond to the Swiss study:

http://afp.google.com/article/ALeqM5j1FyuW1cJTGZubudNzH5DbgDH65w
"No one will ever be free so long as there are pestilences."--Albert Camus, "The Plague"

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Offline SteveA

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Re: "HIV-unprotected sex is possible" ?
« Reply #65 on: February 05, 2008, 03:23:29 AM »
The only possible benefit I see to this study would be for Heterosexual couples where the couple was actually interested in conceiving a child during the safest possible window of conditions. Beyond that I'd still say safe sex is required.

Offline Sean Strub

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Re: "HIV-unprotected sex is possible" ?
« Reply #66 on: February 13, 2008, 06:17:47 AM »
long-term non-progressors are individuals who have at least one of the sets of chromosomal deletions associated iwth much slower progression of the disease, although they are hiv positive. Indiviiduals with both sets of deletions appear to be associated with a near-certain inability to acquire HIV and they then not positive.  There is another category the poster might have meant, which is often called Exposed SeroNegatives.  People they know have been exposed and can even isolate viral particles from their bodies, but they have not sero converted and tested positive on the antibody test and it is assumed (largely untested) that they cannot pass the virus on to others as their dose was too weak to cause antibody reaction in thier own bodies.

Offline Sean Strub

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Re: "HIV-unprotected sex is possible" ?
« Reply #67 on: February 13, 2008, 06:23:47 AM »
The othe rissue with the Swiss study is that it raises the question of when and to what extent are people with HIV ought be morally and lesgally obligated to disclose their status.   If this dramatically reduces the chance of transmission, perhaps to the level of average condom use, must serostatus be disclosed?  What if the risk of seroconversion much more, perhaps to once in a million encounters.  Must that be disclosed?  And the level of risk likely to be present in any sexual encounter depneds on the individuals, their specific sexual practicies and what is going on in their bodies at that time,in terms of infectivity and susceptibility.  Venues and partners impact the obligation to disclose.  When a 50 year old man with HIV has sex with a 20 year old, the elder's obligation to disclose is that much greater.  On the other hand, when that same 50 year old is in a sex club, where men are expected to grunt more than talk, disclosure is deemed not only unnecessary, but also specifically unwanted.

This announcement by the Swiss is an importnat one, perhaps a profound milestone for our community, the point where we enlisted the help of science to give us back our right to more normal lives.  That' why this is so threatening.

Sean Strub
PS I apologize for the typos, but I am on an unfamiliar keyboard nad am typing in the dark.  Ann or Andy, feel free to take license if you see obvious problems.  Thanks.

Offline planonstaying

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Re: "HIV-unprotected sex is possible" ?
« Reply #68 on: February 13, 2008, 08:33:04 AM »
There are a lot of new infections in the western world where there is good  access to meds. Does this mean  all new infections are from the under/untreated/ignorant of status?  I know a lot of people have no idea of their status  but damn.  Transmission  rates arent that different from 1995 are they? I dont know that fact.   It sure would seem like a mantra  to scream for increased testing if that's the case. 
If someone tells you  potential consequences of a behavior  it  doesn't  mean they jude you or mit    they may just give a shit about you

Offline racingmind

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Re: "HIV-unprotected sex is possible" ?
« Reply #69 on: February 17, 2008, 10:19:30 AM »
This all seems like a "grabbing at straws" situation.  I'm poz and undetectable. My partner is negative.  There is no way in hell I would ever consider anal sex without a condom no matter what studies are out there to the contrary.  It's simply not worth the risk.  It would be a shame to find out that you were the exception to the rule....

Tested Negative: 5/06
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1/07: CD4: 440 (27%) VL: 75,286
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Offline J.R.E.

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Re: "HIV-unprotected sex is possible" ?
« Reply #70 on: February 17, 2008, 10:24:47 AM »
This all seems like a "grabbing at straws" situation.  I'm poz and undetectable. My partner is negative.  There is no way in hell I would ever consider anal sex without a condom no matter what studies are out there to the contrary.  It's simply not worth the risk.  It would be a shame to find out that you were the exception to the rule....



There is no way I would toss the condoms either ....


Ray
Current Meds ; Viramune, Epzicom, 40mg of simvastatin, 12.5mg of Hydrochlorothiazide.
Metoprolol tartrate 25mg



http://forums.poz.com/index.php?topic=40802.0

http://forums.poz.com/index.php?topic=45159.0

http://forums.poz.com/index.php?topic=39722.msg495621;topicseen#msg495621

http://forums.poz.com/index.php?topic=46806.0

http://forums.poz.com/index.php?topic=39414.msg491701#msg491701


 In October of 2003, My t-cell count was 16, Viral load was over 500,000, Percentage at that time was 5%. I started my first  HAART regimen  on October 24th,03.

 As of 6/4/14,  t-cells are at 423, Viral load <40

 Current % is at 13% 

  
 62 years young.

Offline aquariusfrance

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Re: "HIV-unprotected sex is possible" ?
« Reply #71 on: February 21, 2008, 01:53:47 AM »
It would be good if we could leave condoms behind....  but I was infected by a girl who was on HAART meds, ... I saw her taking the meds in the restaurant before we spend " the night " together....  she said that it were "vitamins".... we had 3 times sex during that night... 1 time without condom untill she said - after I asked - that she was not on birth control pills....  and 2 times with a condom she took out of her purse of which I saw the next morning that it was a lambskin condom... not protecting for HIV....  18 days later i seroconverted and was diagnosed hiv positive...  vl load > 300.000 ...... CD4 1250 45 % they gave me HAART including Kaletra.... that's when I immediately  recognised the "vitamins" the girl had been taking in the restaurant.... the large orange Kaletra pill....  I had no other sex with other people in the 3 months before nor in the 18 days after this "night", exept with my real gilfriend with whom I was living with at that time.... and she turned out to be negative after I seroconverted.... we had a lot of sex together in the 18 days between that restaurant night and my seroconversion and she did not get infected even with my high viral load.... so I think it is more of  personal resistance to infection that plays a big role if you get infected or not. i think the girl that infected me was on meds since a long time as she was taking the 3 or 4 large pills as if it were really .... vitamins...  for info my real girlfriend left me after a couple of months and i am now living with a positive girl that I met on your poz personals website and we enjoy a lot of sex... without condoms.... and we are both not on meds with high CD4 and low VL... and I hope it stays like that for a long time to come.

Offline J.R.E.

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Re: "HIV-unprotected sex is possible" ?
« Reply #72 on: February 21, 2008, 07:26:01 AM »
It would be good if we could leave condoms behind....  but I was infected by a girl who was on HAART meds, ... I saw her taking the meds in the restaurant before we spend " the night " together....  she said that it were "vitamins".... we had 3 times sex during that night... 1 time without condom untill she said - after I asked - that she was not on birth control pills....  .

Hi,


Just wondering, were you a member of the forums at another time. I seemed to have read same similar incident, quite a while back...


Ray
Current Meds ; Viramune, Epzicom, 40mg of simvastatin, 12.5mg of Hydrochlorothiazide.
Metoprolol tartrate 25mg



http://forums.poz.com/index.php?topic=40802.0

http://forums.poz.com/index.php?topic=45159.0

http://forums.poz.com/index.php?topic=39722.msg495621;topicseen#msg495621

http://forums.poz.com/index.php?topic=46806.0

http://forums.poz.com/index.php?topic=39414.msg491701#msg491701


 In October of 2003, My t-cell count was 16, Viral load was over 500,000, Percentage at that time was 5%. I started my first  HAART regimen  on October 24th,03.

 As of 6/4/14,  t-cells are at 423, Viral load <40

 Current % is at 13% 

  
 62 years young.

Offline newt

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Re: "HIV-unprotected sex is possible" ?
« Reply #73 on: February 21, 2008, 07:33:07 PM »
I don't know anyone in a positive-negative relationship who use condoms apart from me.  But there must be, this is only 9 couples eh?

All the +ve folk are on treatment and have undetectable viral load.

This is (a) their choice(b) an unscientific sample -- clearly they have made their own risk assessment. 

I note:

1/ I tend to know "progressive" aka leftfield people -- I m not sure the science is a factor, they just don't wanna...

2/ There is no "right" answer to this question really, it is up to the people concerned

3/ They don;t -- ahem -- play away

4/ They's a mix of straight n queer folk

5/ 1 guy has ended up HIV-positive but, on reflection, he played away several times....hmmm

6/ 8 have maintained their sero-difference (and they are shagging)..none played away...hmmm

I personally..in truth I dunno, prob would end up being unintentionally inconsistent on condom use and therefore anxious, celibate or in a relatonship with another HIV-positive person (currently first option).

Science/informed opinions are not a good aid to anxiety management.

We aim to stage a London head-to-head of the Swiss lot n someone else to argue the case for and against later this year.  Meantime, if you get to/follow the BHIVA Belfast conference this Spring the community slot is on exactly this issue, and will hear from DR H or one of his confederates and a UK doc who is more cautious in his conclusions. This debate will be thoroughly reported and I will (remember Matt please) post a link to the write-up.

- matt
"The object is to be a well patient, not a good patient"

Offline BT65

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Re: "HIV-unprotected sex is possible" ?
« Reply #74 on: February 21, 2008, 10:59:30 PM »

We aim to stage a London head-to-head of the Swiss lot n someone else to argue the case for and against later this year.  Meantime, if you get to/follow the BHIVA Belfast conference this Spring the community slot is on exactly this issue, and will hear from DR H or one of his confederates and a UK doc who is more cautious in his conclusions. This debate will be thoroughly reported and I will (remember Matt please) post a link to the write-up.

- matt


Matt, I look forward to your report.
I've never killed anyone, but I frequently get satisfaction reading the obituary notices.-Clarence Darrow

Offline John2038

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Re: "HIV-unprotected sex is possible" ?
« Reply #75 on: July 25, 2008, 07:28:45 AM »

A dangerous precedent in HIV
Published: Thursday, 24-Jul-2008

Infection with HIV could quadruple in certain populations if people with HIV follow potentially misleading advice contained in a statement from the Swiss Federal Commission for HIV/AIDS, University of New South Wales (UNSW) research warns.

The research from UNSW's National Centre in HIV Epidemiology and Clinical Research (NCHECR) calls into question the conclusions reached by experts from the Swiss Federal Commission for HIV/AIDS that stated that people with HIV receiving effective antiretroviral treatment could not transmit the virus to their HIV-negative partner through sexual contact.

"If the Swiss Commission's conclusions were adopted at a community level and resulted in reduced condom use it would be likely to lead to substantial increases in infection," says Dr David Wilson, a mathematical modeling expert from NCHECR.

The new research which is published in The Lancet this week (Friday 25th July) also notes potential legal implications for people who believe themselves to be non-infectious but go on to have unprotected sex and infect their partner.

Dr Wilson is the first author on a paper that predicts that HIV transmission over a ten-year period would be four times higher in serodiscordant couples who abandon condom use than if condoms had been used.

The research is based on mathematical modeling in a population of 10,000 couples where one is HIV positive and the other is HIV negative. It found that there would be 215 female-to-male transmissions, 425 male-to-female transmissions and 3,524 male-to-male transmissions in each 10,000 couple group.

"While it is true that the individual risk of HIV transmission per act is fairly small for people on antiretrovirals, the risk of transmission over large numbers of acts could be substantial," says Dr Wilson.

"When the viral load goes down in the blood due to antiretrovirals, it might not go down in the semen or vaginal and anal fluids," says Dr Jonathan Anderson, the president of the Australasian Society for HIV Medicine, who is also based at NCHECR. "This may be confusing. Antiretrovirals can complement consistent condom use but replacing condom use with medications may end in disaster."

Other factors that increase the risk of HIV transmission include incomplete adherence to therapy, changing drug regimes and infection with other sexually transmitted diseases.

"People who are diagnosed with HIV infection tend to reduce their number of new sexual partners, use condoms more consistently and disclose their status to their current partner or partners," says Dr Anderson. "We are concerned that there may not be the same behaviour if people believe themselves to be non-infectious."

The Australian Federation of AIDS Organisations, the National Association of People Living with HIV/AIDS, the Australasian Society for HIV Medicine and NCHECR have produced a statement on antiretrovirals and infectiousness.

Australasian statement on antiretrovirals and infectiousness

Consistent use of effective antiretrovirals will, in most cases, lead to an undetectable viral load, as measured in blood, semen and vaginal fluids. As a result, the average viral load of the community of people living with HIV will be reduced.

By reducing the viral load, antiretrovirals will also complement the benefits of consistent condom use and effective STI detection and treatment, in preventing HIV transmission that may otherwise occur due to condom failure.

However, there are no data to suggest that a population HIV prevention strategy based solely or predominately on the use of antiretrovirals and associated with a reduction in condom use, will lead to fewer people becoming infected in the Australian and New Zealand populations, especially in the context of rising rates of sexually transmitted infections.

The Australian Federation of AIDS Organisations, the National Association of People Living with HIV/AIDS, the Australasian Society for HIV Medicine and the National Centre of HIV Epidemiology and Clinical Research (NCHECR)


http://www.news-medical.net/?id=40257
« Last Edit: July 25, 2008, 07:30:20 AM by John2038 »

Offline edfu

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Re: "HIV-unprotected sex is possible" ?
« Reply #76 on: July 25, 2008, 07:50:58 AM »
Thank you, Australia, for some sanity in this controversy.   
"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 John2038

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Re: "HIV-unprotected sex is possible" ?
« Reply #77 on: July 25, 2008, 07:57:16 AM »
The mathematical model (without consideration of the drugs) found that the cumulative probability, with an average of 100 per annum sex without protection, was:

*   0.22% per annum for transmissions woman to man
*   0.43% for transmission from man to woman
*   4.3% for transmission between men.

Offline planonstaying

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Re: "HIV-unprotected sex is possible" ?
« Reply #78 on: July 26, 2008, 08:28:11 AM »
   

May 22, 2008

HIV Infection Often Results From Single Copy of Virus in Cell



While such sexually transmitted diseases as gonorrhea and syphilis invade the body with as many as 10, 20, 100 or 200 bacteria, , scientists from the University of Alabama at Birmingham (UAB) have found that most HIV infections are the result of a single copy of the virus penetrating the body’s defenses, The Birmingham News reports (al.com, 5/20).

“In the vast majority of cases a single virus has gone across the sexual mucosa, and that virus has infected a cell,” said George M. Shaw, lead author on the UAB study published online on Monday by the Proceedings of the National Academies of Science. “That cell then makes a lot of virus. Now you just have a firestorm of HIV replication in the next couple [of] weeks. Very quickly the person is populated by millions of viruses.”

In addition to breaking new ground in understanding the HIV transmission process, this study also showed why condoms are so effective in preventing infection and why efforts to develop viable microbicide gels have proven less so. Shaw told The Birmingham News that unlike microbicides studied thus far—which may not stop all individual viruses from entering the body—a properly used condom stops all of them.












 That would suggust there is no  fully safe BB   
If someone tells you  potential consequences of a behavior  it  doesn't  mean they jude you or mit    they may just give a shit about you

Offline John2038

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Re: "HIV-unprotected sex is possible" ?
« Reply #79 on: August 09, 2008, 09:46:23 AM »
Systematic review unable to confirm or deny Swiss statement on infection risk with undetectable viral load
A systematic review of studies of serodiscordant couples where the HIV-positive partner was on antiretroviral treatment could neither confirm not disprove the recent Swiss declaration of a negligible risk of HIV transmission from a pesron on treatment with undetectable viral load, according to data presented during Thursday afternoon’s late breaker sessions at the XVII International AIDS Conference in Mexico City.

However, the review revealed some new information – that HIV transmission, from an individual not on treatment, had occurred in a 2005 Spanish study at a blood plasma viral load of 362 copies/ml.

The Swiss statement – which has caused controversy since it was published in January 2008 and which was discussed at a pre-conference satellite session last week – asserted that the per sexual act risk of HIV transmission from an HIV-positive individual on treatment with an undetectable viral load and no sexually transmitted infections to their HIV-negative partner is below 1 in 100,000.

To assess whether this was indeed the case, investigators from the University of Bern conducted an extensive search of published studies and conference presentations involving serodiscordant couples since 1996, when effective antiretroviral treatment first became available.

Out of a total of 252 published articles and abstracts only 14 were found to be potentially eligible due to duplication, irrelevant topic or study design, or lack of additional data from the study authors – of these, seven were published or were about to be published, and seven were conference abstracts.

However, their systematic review did not identify any studies that fulfilled the exact criteria of the Swiss statement – where the HIV-positive partner is on antiretroviral treatment, with an undetectable viral load (below 40 copies/ml) for longer than six months with no other sexually transmitted infection (STI), which they defined as syphilis, chlamydia, gonorrhoea, or genital herpes.

Consequently, they included cohorts where the HIV-positive partner was not on treatment; that defined a higher threshold of undetectable viral load (400 copies/ml); and/or where the HIV-positive partner’s STI status was unclear.

The greatest number of discordant couples in these studies came from Africa (1822) with only 424 from Europe. Just one study included gay men or other men who have sex with men (accounting for just 43 couples) with the remaining thirteen cohorts including heterosexual couples. However, none of these studies included detailed information about the specific sexual acts they practised – oral, vaginal and/or anal sex.

Only nine cohorts reported use of antiretroviral therapy in the HIV-positive partner, accounting for 428 couples.

Only one study, from Castilla and colleagues in Spain, published in 2005, reported on HIV-positive individuals on antiretroviral treatment with an undetectable viral load, although the STI status of these individuals remains unclear. In this study, there were no transmissions per 100 person-years from 283.2 person-years of follow-up.

The authors of the systematic review calculated a summary estimate of the HIV transmission rate per 100 person years with a 95% confidence interval (CI) resulting in an upper confidence interval of 1.06 transmissions per 100 person-years.

In the four studies that included HIV-positive individuals with a viral load below 400 copies/ml who were not on treatment but where there was no clear information on STI status, only one transmission occurred over more than 600 person-years. This resulted in a transmission rate of 0.16 per 100 person-years and an upper confidence interval of 1.16 transmissions per 100 person-years.

This single instance of HIV transmission occurred at 362 copies/ml in the blood plasma viral load. This is new information not included in the original article in Journal of Acquired Immune Deficiency Syndromes. Previously, the highest blood viral load threshold published for HIV transmission was around 1500 copies/ml by Quinn and colleagues.

She noted that a recent Australian study, using a mathematic model that assumed there was no threshold viral load level below which transmission would not occur, had concluded that transmission may still occur from gay men who fulfilled the provisos of the Swiss statement and who practised anal sex.

In an online editorial responding to this Australian modelling study, Swiss Federal AIDS Commission President Professor Pietro Vernazza strongly suggests that the Australians’ assumptions are flawed, and highlights the accompanying editorial by Garnett and Gazzard, which pointed out that even if the assumptions in the model were correct, the risks of transmission over 100 sexual acts were similarly low for 100% condom use and unprotected sex on treatment with an undetectable viral load and no STIs.

Systematic review lead author Suzanna Attia conceded that, “a body of indirect evidence suggests that HIV transmission at very low viral loads is very rare. We did not identify any studies or case reports where transmission occurred below 40 copies/ml.” However, on the basis of current evidence, she and her co-authors were unable to confirm or disprove the Swiss statement’s suggested 1 in 100,000 risk of HIV transmission for an individual taking effective HIV treatment with no STIs.

She concluded by stressing that their review was ongoing, and it was hoped that incoming data would allow them to increase the precision of their estimates. 

http://www.aidsmap.com/en/news/F2E2BCFF-26CF-4400-B5AC-0549FBAC940D.asp

Offline newt

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Re: "HIV-unprotected sex is possible" ?
« Reply #80 on: August 09, 2008, 02:58:22 PM »
The mathematical model (without consideration of the drugs) found that the cumulative probability, with an average of 100 per annum sex without protection, was:

*   0.22% per annum for transmissions woman to man
*   0.43% for transmission from man to woman
*   4.3% for transmission between men.

The more correct assertion here is perhaps for the first two between men and women having vaginal sex and for the last between men and women OR men and men having anal sex.

Boy, you don't wanna know how fragile the rectum is re: HIV infection.....

- matt
"The object is to be a well patient, not a good patient"

Offline edfu

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Re: "HIV-unprotected sex is possible" ?
« Reply #81 on: August 10, 2008, 01:18:08 AM »
Boy, you don't wanna know how fragile the rectum is re: HIV infection.....

- matt[/font]

Well, I would disagree with that, Matt.  It is imperative for better prevention that everyone--especially MSM-- knows how fragile the rectum is in this regard.  The fact that this biology is not more widely promulgated in safer-sex campaigns is a scandal.

Compared to unprotected vaginal intercourse, unprotected anal intercourse is 10 to 100 times more likely to transmit HIV.  The lining of the rectum is far more fragile than that of the vagina, and the cells that are open to infection are much closer to the surface.  During anal intercourse this lining may rupture, allowing HIV to break through and infect cells.   
"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 Tempeboy

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Re: "HIV-unprotected sex is possible" ?
« Reply #82 on: August 10, 2008, 03:45:38 AM »
Tricky topic - great thread.  Some more for the mix:

1.   Undectable does not equal zero

2.   Not all meds achieve undectable viral load in seminal plasma - even if a given combo acheives and maintains undetectable plasma viral load in
      blood. 

3.   This is thought to be because not all meds penetrate the seminal vescicles equally - a bit like penetration of the blood brain barrier.

4.   Undectable viral load in seminal plasma does not equate to the absence of HIV in the tissues of the genitals, urinary system or rectum.

5.   If these tissues are compromised because of a lesion resulting from an STI, UTI or other trauma HIV is released into surrounding fluid (blood or
      cum)

6.   The presence of a lesion can be symptomatic or asymptomatic - ie known or unknown.

7.   There are thought to be other unknown causes of viral blips in blood - related causes in cum not inderstood

So.................

If you are able to take certain meds ie allowing for side effects, resistance and availability

and

You can guarantee 100% medication adherence for yourself and partners

and

If you can guarantee absence of STI's, UTI's or trauma in yourself and your partner(s)

and

You have a teflon rectum

and

You are happy to take the risk of superinfection, other STI's including HCV  -  10-13% of people with HIV are HCV positive as well - higher in areas without access to clean condoms and injecting equipment.

...........then give it a go.  The theory that these strategies might work fall down when we consider that they all hinge on the ablility of the participants to be open and honest about sex with all of their partner's. 

I can hear it now 'No we don't need to use condom's, I'm undetectable and STI free.  Here have another line and let's........"

This model does have proven success with couples trying or needing to conceive naturally.  During the time when the coupld plan to conceive the positive partner is on meds with 6months consistent undectable results and the neg partner is given PrEP.  Couples can choose to conceive naturally or 'spin the sperm' also called sperm washing.  This is good news for people who don't have access to other family planning options but should not equate to messages suggesting that we can dispense with condoms.  It is important to note also that couples trying to conceive are good will do just about anything for a healthy baby.

Roughly roundabout somewhere in the eighteenth or nineteenth century, Sodomite begat Homosexual out of moral, medical and legal models, bequeathing him Identity, who inbred with Nuclear Family and Industrialism to spawn Homophobia.

Dean Kiley

Offline John2038

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Re: "HIV-unprotected sex is possible" ?
« Reply #83 on: October 23, 2008, 02:16:09 PM »
I posting this here to have all in one thread.

Shouldn't this a case be reported as HIV transmission occurring while undetectable ?

A 50-year-old GWM was diagnosed with acute HIV seroconversion in November 2003 after failing post-exposure prophylaxis (PEP). His risk factor for HIV infection was anal receptive intercourse with ejaculation after a broken condom occurred on 9/21/03. His partner was known HIV positive, and had by report an undetectable viral load (VL) on an unknown antiretroviral regimen. The patient reportedly received 28 days of PEP with Combivir (CBV) + lopinavir/ritonavir (LPV/r, Kaletra). The time after exposure to starting PEP was unclear but was likely within 24 hours. He reported complete adherence with the PEP regimen. In November (11/26/03) the patient experienced night sweats and fatigue with a negative HIV antibody test and a high VL. He was enrolled in the Options research project for recent HIV seroconverters.

Source

Offline newt

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Re: "HIV-unprotected sex is possible" ?
« Reply #84 on: October 23, 2008, 04:20:30 PM »
The trouble with case reports is the report bit. Given the man's extensive very treatment related mutation profile it is at least possible we do not have the whole truth.

There's also this (perhaps more compelling) report:

Case report of sexual transmission when viral load suppressed to <50 copies/mL in monogamous male couple
http://www.i-base.info/htb/v9/htb9-9-10/Case.html

Nonetheless, viral suppression reduces the risk many, many hundreds of times, and, from a public health point of view, it is a good question whether it is right to emphasise very small risks.

If oral sex between men of unknown HIV status is not considered a major driver of the epidemic then sex between people of different antibody status where the HIV-positive one consistently has very low viral load is not one either. The risk is comparatively the same (or even less on current estimates). But that don't mean there will be no cases of transmission by either route.

Nerdy types interested in heterosexual risk estimates may enjoy:

Common estimate of heterosexual HIV transmission risk sometimes far too low
http://www.i-base.info/htb/v9/htb9-9-10/Common.html

- matt
"The object is to be a well patient, not a good patient"

Offline mecch

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Re: "HIV-unprotected sex is possible" ?
« Reply #85 on: October 23, 2008, 06:00:39 PM »
I have been doing an survey of the limited number of gay guys I can manage to chat with who are hiv positive, willing to say so, and willing to answer this question: do you use condoms when you have sex with another hiv+ guy.  Most say No. Rarely. Why bother.
Maybe my survey is fucked on a number of counts.
Anyhow, I guess I thought it might be easier to have sex with other poz guys, but now I'm thinking the safer sex questions are going to be just as challenging with hiv+ guys as with a hiv- guys.  Shit.
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline John2038

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Re: "HIV-unprotected sex is possible" ?
« Reply #86 on: April 22, 2009, 08:47:49 AM »
German NGO endorses treatment as prevention
Tuesday, April 21, 2009

Deutsche AIDS-Hilfe, the largest HIV voluntary sector organisation in Germany has issued a position paper on the role of treatment in HIV prevention which broadly echoes and supports last year’s landmark Swiss statement on the limited risk of a person taking effective HIV treatment passing on their infection.

Whereas the Swiss had stated in definitive terms that people on effective combination therapy and without any sexually transmitted infections cannot sexually transmit HIV, the German paper describes transmission in these circumstances as “unlikely”, and suggests that this approach is as effective as the use of condoms.

Moreover, the Germans stress the importance not only of sexually transmitted infections, but also of other health problems which can damage mucous membranes, and so increase the risk of HIV transmission.

January 2008’s statement from leading Swiss HIV doctors argued that HIV-positive people who were taking antiretroviral therapy with an undetectable viral load in their blood and no sexually transmitted infections could not pass on HIV to their sexual partners.

According to Deutsche AIDS-Hilfe, if the following conditions are met, the sexual transmission of HIV is unlikely:

    * The HIV positive partner’s viral load has been undetectable for at least six months.
    * There is good adherence to antiretroviral treatment.
    * There is no damage to mucous membranes.


They say that in these circumstances, the risk of HIV transmission is negligibly low, and is comparable to the transmission risk with 100% condom use. If an individual combines condom use with controlled viral load, then the transmission risk is described as close to zero.



More

Offline bocker3

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Re: "HIV-unprotected sex is possible" ?
« Reply #87 on: April 22, 2009, 10:25:11 PM »

    * There is no damage to mucous membranes.

Yet the sexual intercourse itself could damage mucous membranes................... 
Seems like this condition alone still leaves more risk than I would be willing to take, as you can't ever know if you've "broken" the condition until after.

Mike
Atripla - Started 12/05
Reyataz/Norvir - Added 6/06
Labs - Pre-Meds
Sep05 T=350/25% VL98,559
Nov05 288/18%  47,564
Current Labs
May2013 691/31% <20

Offline dtwpuck

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Re: "HIV-unprotected sex is possible" ?
« Reply #88 on: April 22, 2009, 10:34:41 PM »
I have been doing an survey of the limited number of gay guys I can manage to chat with who are hiv positive, willing to say so, and willing to answer this question: do you use condoms when you have sex with another hiv+ guy.  Most say No. Rarely. Why bother.
Maybe my survey is fucked on a number of counts.
Anyhow, I guess I thought it might be easier to have sex with other poz guys, but now I'm thinking the safer sex questions are going to be just as challenging with hiv+ guys as with a hiv- guys.  Shit.

Meech...   I have been poz for 13 years.  In the first 11 years of that time I  had sex more times than I can count with other poz guys.  I confess to serosorting.  Not once did any other poz guy want to use a condom.  Not once.  Ever.    You'd think that I'd run into someone who wanted to.    Anyway, it never happened.      So maybe your survey is fucked.  Maybe not.  But, I personally believe that when the rubber hits the road, so to speak, men will be men, and will choose not to use them.   

Floating through the void in the caress of two giant pink lobsters named Esmerelda and Keith.

Offline lonewolf

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Re: "HIV-unprotected sex is possible" ?
« Reply #89 on: April 23, 2009, 12:26:04 AM »
As uneducated as I am and only being POS for the past 3 years or so.
To me the bottom line and common sense is:
We are infected with HIV,  an incurable virus, undetectable or not.
Safe sex is ONLY with a condom.

I certainly would not want to go with the mindset that I am "undetectable" and can fuck around as I see fit, whether it be hetero, or bi, or gay.   

Until they find a cure to completely ELIMINATE  this virus from every cell of my body,  safe sex is the only way to go, for me, and for my partner.
"To all within the sound of my voice, I appeal: Learn with me the lessons of history and of grace, so my children will not be afraid to say the word “AIDS” when I am gone. Then, their children and yours may not need to whisper it at all."  Mary Fisher

Offline edfu

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Re: "HIV-unprotected sex is possible" ?
« Reply #90 on: April 23, 2009, 11:48:47 AM »
Recent frightening studies have shown almost universal (70-98%) anal infection with HPV (human papilloma virus) amongst gay men, with a rate of 70% in HIV-negative men, and 94-98% in HIV-positive men:

http://www.aidsmap.com/en/news/44684313-9869-4FE9-BFE4-2B7CB5859216.asp

http://www.aidsmap.com/en/news/1D283AC1-8C8B-4DDB-88EB-E490C194B13D.asp

http://www.aidsmap.com/en/news/7C545A52-BBA5-4CCE-AC5B-92E6437E0E66.asp

It seems to me that these findings indicate an extremely high potential for damaged anal mucous membranes.  How can it ever be assumed, therefore, that a gay man does not have low-grade anal lesions or high-grade pre-cancerous lesions?     

The failure of Deutsche AIDS-Hilfe to address this problem is simply astonishing to me. 
« Last Edit: April 23, 2009, 12:34:11 PM by edfu »
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Offline Ann

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Re: "HIV-unprotected sex is possible" ?
« Reply #91 on: April 23, 2009, 12:10:17 PM »

January 2008’s statement from leading Swiss HIV doctors argued that HIV-positive people who were taking antiretroviral therapy with an undetectable viral load in their blood and no sexually transmitted infections could not pass on HIV to their sexual partners.


How odd. Maybe Deutsche AIDS-Hilfe read a different version of the Swiss Statment to the one I read. I could have sworn that the Swiss Statement I read stated that it was UNLIKELY for a patient meeting their criteria to pass their virus on, not that they COULD NOT pass their virus on.

But anyway, this article isn't looking at poz on poz sex (I don't understand where the poz on poz comments have come from), it's looking at poz on neg sex. It's foolish for them to write this article in such a way that it makes it sound ok to have poz/neg sex without condoms, as long as the poz partner is and has been undetectable for six month or more. I would have been happier if the emphasis was on reassuring people that a broken condom on an insertive poz partner would be unlikely to result in transmission to the neg bottom or neg vaginal partner.

It makes me worry that some poz people will take this as license to bareback with negative partners, given the way this article is written. While it may be appropriate in the context of a long-term, monogamous relationship where the pros/cons and risk levels have been thoroughly discussed and agreed upon, it's not appropriate AT ALL to release a news item that makes it sound like it's ok right across the board.

~sigh~

Ann
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"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline mecch

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Re: "HIV-unprotected sex is possible" ?
« Reply #92 on: April 29, 2009, 11:49:08 AM »
 unprotected sex between HIV+ and HIV+ gay men seems to be a quagmire, and incredible difficult subject, if not act (what could be more "natural").

Ann says "It makes me worry that some poz people will take this as license to bareback with negative partners, given the way this article is written."

Ann, ask around London. Its already true in some gay capitals.  And I know a few gay HIV+ guys in switzerland who will bareback anyone, HIV+ or HIV-, under the rationale, "I'm undetectable."  They do NOT annouce this, but do respond honestly when questioned.  When not announced, the rationale is, "HIV- people should protect themselves, and anyway, I am undetectable."

I know one untreated HIV+ guy who will bareback with anyone and he also does not announce.

I think in a few years, it will be quite common for an all new kind of sero-sorting. (Is it already?)

We will have:
HIV- (and recently and regularly tested)
HIV+ and untreated
HIV+ and undetectable
"Don't know"

These HAART treated guys I refer to above almost promote themselves as "undetectable" in a way that pushes many people's buttons.

We will see who will be doing whom, and whether safe sex or not.

William F. Buckley (RIP), odious type, in 1986, proposed tatooing HIV+ status and it was horrible and interesting suggestion because the point was, we need a lot more honesty and clarity but there is an human inclination to not ask, or not tell.  We got safe sex out of that, which works, but then it started to all be negotiable again (as a population, when for many never negotiated as an individual). And then infections rose again in the Gay community.

I was reading an article recently about HAART developments and the scientist said, well, isn't it interesting that we have a very treatable disease, that is transmissable, and keep asking the question, when to start the treatment?   

The other thing is that we're at the point now where we've got this disease that's quite easily treatable with very effective treatment. I'm trying to think of some other infectious disease where you would have to prove that it was OK to treat.

HIV is unique in that the burden of proof seems to rest on those who want to treat early. Whereas for another infectious disease, you'd say, "Show me that I can wait. Show me that it's safe to wait." The reason for that is historical. It's not medical.

It's because first we didn't have treatment. Then we had lousy, ineffective treatment. Then we sort of had lousy, effective treatment. Now we have good, effective treatment. And because it's gone in that direction, we've approached it from the opposite direction, where the default is not to treat, and what you have to prove is a reason to treat.


http://www.thebody.com/content/confs/croi2009/art50660.html

So treatment has individual health benefits, at the right time, and looks like the pendulum is going to swing back to treatment at acute phase. But the quagmire results because doctors and researchers are increasingly talking about how effective treatment has benefits for a POPULATION.

In a perfect world, if everyone were routinely tested and universally treated if infected with HIV, how long before the epidemic runs its course and number of new infections drop dramatically??

The only problem with that is, yes, people have the right to refuse treatment. But then, do they have the "right" to all the fun and games of "unsafe" sex?

Does ANYONE know statistics from Berlin, recently. BB is quite the norm in cruisy situations. Have infections gone up, or are most HIV+ people "undetectable" and infection rates staying the same?

What a quagmire.
« Last Edit: April 29, 2009, 12:12:16 PM by mecch »
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Offline Ann

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Re: "HIV-unprotected sex is possible" ?
« Reply #93 on: April 29, 2009, 02:10:48 PM »
Mecch,

One of the problems I have with poz, undetectable people barebacking with negs is that chances are going to be better than usual that they're going to have one of the bacterial STIs - and the presence of STIs have been shown to increase the amount of virus in the genital tract. We already know that men can have detectable levels of virus in their semen, even though they are undetectable blood-wise.

A quagmire indeed.

I'm not so sure about the push to treat right away, even when numbers don't indicate. Although the meds today are better, we only know about them in the short-term so far. I'm twelve years med free and I'd be pretty damned pissed off if someone tried to tell me I HAD to go on treatment because of the onward-transmission factor. I'm an adult, I use condoms with people of unknown or negative hiv status. I feel like it's saying - here, take these heavy-duty meds that may or may not come with side-effect, just because we can't trust you to use condoms.

Total nanny-state thinking.

Maybe we'd just do better to shut these idiots up (like Deutsche AIDS-Hilfe) who claim that the Swiss Statement says that undetectables CANNOT pass their virus on - because it's simply NOT TRUE.

Ann
Condoms are a girl's best friend

Condom and Lube Info  



"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

 


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