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Author Topic: transmitting hiv on meds  (Read 4137 times)

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Offline jportland

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transmitting hiv on meds
« on: March 29, 2009, 03:56:49 PM »
With all of this talk of some docs saying that a person who has been on meds for about a year and has an undetectable viral load and that has unprotected sex with their partner is  less likey to give the other person hiv got me wondering...  I mean I did hear that it was less likely in hetrosexual sex if they were undetectable to spread the virus but I was wondering is it also less likey for male to male sex if the person is on meds but has an undetectable viral load to pass it on?
                  I have come to terms with my hiv but I do know that the person that I got it from WAS on hiv medication.  I do not know for sure if his viral load was undetectable but I am pretty sure it may have been.  So if a gay male has sex with a male and has an undectable viral load versus a gay male that has a dectable viral load has sex with a male, is the guy with an undectable viral load a little less likey to pass on the virus?  I mean I know protected with both is what one should do at all times but am just curious if the odds are a little bit less likely perhaps in a person with an undetectable viral load.  And also why is it even MORE less likey with hetrosexual couple when one has an undectable viral load? ( although still not impossible...) 
                  If the person that gave it to me had an undetectable viral load then it would prove any of these scientists wrong that are saying this that it is nontransferable although perhaps less likely... But I just wonder if there are statistics as to HOW less likely and is it more of a freak thing now days to get hiv from someone that has an undectable viral load versus someone that is not on meds and has a large viral load.
2001 tested neg
8/2002  seroconvert
9/2002 Tested Poz
No Meds
2/2003 302/25% 76K
9/2004 463/23% 14K
8/2005 342/22% 19K
7/2006 381/29% 24K
3/2007 386/34% 34K
3/2008 230/21% 269K
3/2008  Started Meds
7/2008 485/23% VL 140
9/2008 465/24% VL Undetectable
1/2010 581/29% VL Undectectable

Offline Inchlingblue

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Re: transmitting hiv on meds
« Reply #1 on: March 29, 2009, 04:39:24 PM »
It has recently been found that despite undetectable viral loads in the blood, HIV is still found in the semen.

Here is an article from CROI:

HIV in Semen Despite Undetectable in Blood: "residual risk of transmission is still possible during unprotected intercourse"

http://www.natap.org/2009/CROI/croi_157.htm

Offline Ann

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Re: transmitting hiv on meds
« Reply #2 on: March 29, 2009, 06:51:27 PM »
j,

The difference is between vaginal and anal sex. A heterosexual couple who practice anal sex is at greater risk, just like a MSM gay couple. The difference is that the walls of the vagina are thicker and more resiliant and less likely to become damaged during intercourse. The anal/rectal walls are much thinner by comparison and more prone to damage.

A person with an undetectable viral load is  less likely to pass on the virus, although it's not impossible.

Ann
Condoms are a girl's best friend

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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 dtwpuck

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Re: transmitting hiv on meds
« Reply #3 on: March 29, 2009, 08:59:03 PM »
Just because something is statistically less likely does not mean it is not statistically possible. 

Let's just say for argument sake that a person who is undetectable is 1/10th as likely to pass the virus on than a person with a detectable viral load.   

Now, let's say this person has unprotected sex 100 times over the course of the year. 

Would you want to take the chance of being one of the ten?

Now let's assume that you have unprotected anal intercourse with this person 100 times over the course of the year. . .

Catch my drift?   Being undetectable does not absolve one of the responsibility to have protected sex.  Nor does it absolve negative people from the responsibility of protecting themselves and acting responsibly.

I will now gingerly step off my soap box.

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

Offline David_CA

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Re: transmitting hiv on meds
« Reply #4 on: March 29, 2009, 09:31:31 PM »
Also, the likelihood of transmission depends on what 'role' the HIV+ individual is taking.  In other words, is he the pitcher or the catcher? 
Black Friday 03-03-2006
03-23-06 CD4 359 @27.4% VL 75,938
06-01-06 CD4 462 @24.3% VL > 100,000
08-15-06 CD4 388 @22.8% VL >  "
10-21-06 CD4 285 @21.9% VL >  "
  Atripla started 12-01-2006
01-08-07 CD4 429 @26.8% VL 1872!
05-08-07 CD4 478 @28.1% VL 740
08-03-07 CD4 509 @31.8% VL 370
11-06-07 CD4 570 @30.0% VL 140
02-21-08 CD4 648 @32.4% VL 600
05-19-08 CD4 695 @33.1% VL < 48 undetectable!
08-21-08 CD4 725 @34.5%
11-11-08 CD4 672 @39.5%
02-11-09 CD4 773 @36.8%
05-11-09 CD4 615 @36.2%
08-19-09 CD4 770 @38.5%
11-19-09 CD4 944 @33.7%
02-17-10 CD4 678 @39.9%  
06-03-10 CD4 768 @34.9%
09-21-10 CD4 685 @40.3%
01-10-11 CD4 908 @36.3%
05-23-11 CD4 846 @36.8% VL 80
02-13-12 CD4 911 @41.4% VL<20
You must be the change you want to see in the world.  Mahatma Gandhi

Offline texasangel071184

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Re: transmitting hiv on meds
« Reply #5 on: March 29, 2009, 11:48:21 PM »
yeah  i agree with you there dave also though while alot of people may not be aware of this fact you can and are able to pass hiv and other std through precum so that mean just preforming oral can transmit it! flavor condom are the way to go! lol ;D ;)
I live, I breath, I defie, I succeed!
who are you to tell me i can't, I can and I will!

Offline John2038

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Re: transmitting hiv on meds
« Reply #6 on: March 30, 2009, 04:29:39 AM »
At least 2 cases of infection have been reported while one of the partner was undetectable and the other HIV-.

Another question that I believe have not yet been answered is:

If both of the partners are satisfaying the Swiss Statement (undetectable, no ists, more than 6 months on treatment, etc), is there a risk for them to become superinfected and/or to get the eventual resistances from each others ?

I guess this is the last scenario where unprotected sex can be debated.  :(


Offline mecch

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Re: transmitting hiv on meds
« Reply #7 on: March 30, 2009, 02:41:31 PM »
The Swiss model also says you must be heterosexual and under very close medical supervision.  So don't extrapolate the Swiss result for gay male partners, at least.
ďFrom each, according to his ability; to each, according to his needĒ 1875 K Marx

Offline newt

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Re: transmitting hiv on meds
« Reply #8 on: March 30, 2009, 07:32:32 PM »
There's a fair bit of ill-thought and out-of-date science here.

For a start, this paper argues that the estimates for heterosexual transmission are sometimes far too low - putting "gay" sex within the top of the "normal" range for vaginal penetration perhaps (but I do take Ann's point about no study seriously). 

And perhaps it is possible, common even in places (like the Vatican eh?) that heterosexuals have anal sex.

Among other things.

A person who is undetectable is considerably more than 10 times less like to transmit HIV than someone with a modest, average viral load, say 50,000, gay or straight.  30 times? 81 times? 250 times? prob somewhere around 80-100 times less.

Sex 100 times a year!?!? hmmm.

Transmission is not Russian roulette, the barrel don't click round til someone gets a bullet in the head, the risk is the same on each occasion (for shooters, this is like spinning the barrel between every shot in the gun roulette scenario, resets the odds, not how I played in Russia << with a cap gun).

There are perhaps 2 cases of transmission from a person with <50 copies viral load in the literature. There is also 1 case of community acquired transmission, ie through some dumb household dishygeine. These are called outliers, ie they don't count when determining the statistical risk of things in general. They are unusual events, which is why doctors get to present them at conferences. 

The mere possibility of superinfection between 2 people with suppressed viral load I don't buy. There's not enough virus and meds are themselves protective.

Yer, I know, the ifs and buts, did he take his meds? and all that. But this is just not worth a worry (as long as he took his meds). He probably did take his meds. He'd have tpo be off them a few days for the virus to fire up again.

The Swiss analysis puts the risk of transmission from someone with a suppressed viral load with no genital ulceration having sex with a regular partner within the realms of "risks of normal life". Like being run over by a bus or falling off your chair and breaking your leg. It will happen but do you worry about it much? Skydiving for charity is much more dangerous to life and limb << this is very dangerous, 135 times more dangerous than risks of normal life sez the American Society of Actuaries (if my memory serves me well at this late hour).

The long and the short of is, anal or otherwise, sex with your regular man/woman with well suppressed viral load is very, very low risk. Different people will decide the risk and benefits play out differently here, according to their understanding of the science, boredom, anxiety, temperament, trust, intimacy, love, lust, vanity and/or naivety. And perhaps even the need/right to the feeling of some degree of normal life. And perhaps with the need/right to protect themselves and others. And also perhaps as to whether you snarfed one of your partner's Truvada before you said to him to leave off the condoms.

Big mix that.

There is no right answer. Just a personal one.

- matt
« Last Edit: March 30, 2009, 08:02:34 PM by newt »
"The object is to be a well patient, not a good patient"

Offline jportland

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  • Posts: 62
Re: transmitting hiv on meds
« Reply #9 on: April 08, 2009, 07:50:28 AM »
Thank you all for your insightful responses.... Newt, in your reponse at one point you wrote this.... "Yer, I know, the ifs and buts, did he take his meds? and all that. But this is just not worth a worry (as long as he took his meds). He probably did take his meds. He'd have tpo be off them a few days for the virus to fire up again. "
          So I was told that when I was diagnosed that I cannot take one WHOLE set of drugs. They include Sustiva and 2 other drugs that make up one whole class of drugs.  I was told that the person that infected me was taking drugs and passed on to me this mutation because he WAS ON hiv meds! So I am lost when in this study as from the topic of all of this in the Swiss Study said it was maybe ok to have sex with an undetectable viral load? 
                         It would make sense to me to say NO it doesn't work! All it does is pass on the virus on TOP of the fact that you will be passing on a strain that already has a one full class of drugs the person that you gave it to cannot take and are of no use to them! 
                        That was hard to take when I was first diagnosed.  Not only had I just found out I was hiv positive but I was then told that I could not use all 3 classes of drugs and that I could only use drugs between 2 classes of drugs making me very upset.  So I am just lost I guess on why or how it is not passed on versus the fact that I got hiv from someone on meds and I got a worse strain on top of it! So what I am saying is that I would assume that anyone who had sex with someone with hiv that was on meds would end up just like me.  I would assume as well that everyone would end up with a bad strain like me BECUZ the person was ON meds. So how it makes no sense to me why they would say it is ok to have sex after being on meds. I had sex with someone on meds and I still got hiv.
2001 tested neg
8/2002  seroconvert
9/2002 Tested Poz
No Meds
2/2003 302/25% 76K
9/2004 463/23% 14K
8/2005 342/22% 19K
7/2006 381/29% 24K
3/2007 386/34% 34K
3/2008 230/21% 269K
3/2008  Started Meds
7/2008 485/23% VL 140
9/2008 465/24% VL Undetectable
1/2010 581/29% VL Undectectable

Offline Ann

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Re: transmitting hiv on meds
« Reply #10 on: April 08, 2009, 08:06:25 AM »
j,

You might want to have a look at the Understanding Drug Resistance Lesson.

The person who passed his resistance on to you - he most likely didn't have an undetectable viral load, and may not even have been on meds when you two got together. He may have discontinued taking meds, or he may have been infected with a drug resistant strain himself and treatment naive (had never taken meds at all). 

He also may have been taking meds, but newly resistant where it hadn't yet turned up in his blood tests. As most people on meds go between three and six months between blood draws, this is totally possible.

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

Offline John2038

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Re: transmitting hiv on meds
« Reply #11 on: April 08, 2009, 09:32:19 AM »
Food for thoughts..

The "Swiss Statement"

The "Swiss Statement" was an information to Swiss physicians that the Swiss Commission on AIDS-related issues presented issued in January 2008. It said that physicians could inform their patients that the sexual transmission risk to the partner is negligibly low if three conditions were met:

    * HIV-infected patient is under a physician controlled antiretroviral therapy with excellent adherence
    * Blood viral load has constistently been undetectable (<40cp/ml) for more than 6 months
    * no sexually transmitted diseases are present in neither of the partners

The statement also made clear, that it is only the HIV negative partner who can decide for himself whether he/she wants to stop using condoms with the treated partner.


Note
Patients treated for HIV, with undetectable viremia, are no longer infectious: arguments for and against - Interview with Pr. Bernard Hirschel:
Interview 1, Interview 2 (aidsmeds), Video (aidsmeds)


The Australian mathematical model



Note
The Australian study supports the Swiss statement


Reported cases of infection while undetectable

Case 1, Case 2


Drug level in the male genital tract



Note (John2038)
Uncertain source


Estimated per act risk for acquisition of HIV, by exposure route



Note (John2038)
Recommended reading



The effects of intermittent sexually transmitted disease infections on the probability of sexual transmission of HIV.



The Effect of HAART on Infectiousness (written by Pr Bernard Hirschel) - Powerpoint



EDIT 1
Shortenen the post

EDIT 2
Thumbails + use of a single image repository
« Last Edit: April 09, 2009, 03:57:49 PM by John2038 »

Offline sharkdiver

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Re: transmitting hiv on meds
« Reply #12 on: April 08, 2009, 09:56:10 AM »
 wouldn't a weblink been sufficient?  Makes the discussion hard to follow

Offline Miss Philicia

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Re: transmitting hiv on meds
« Reply #13 on: April 08, 2009, 02:46:17 PM »
/blog
"Iíve slept with enough men to know that Iím not gay"

Offline John2038

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Re: transmitting hiv on meds
« Reply #14 on: April 08, 2009, 06:51:48 PM »
Name:     Miss Philicia
Posts:    9,664 (9.821 per day)
Date Registered:    July 29, 2006, 05:37:06 pm



"Miss Philicia" don't post for nothing

Offline newt

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Re: transmitting hiv on meds
« Reply #15 on: April 08, 2009, 08:43:33 PM »
JP

My comment in relation to "ifs and buts" is about the addition to this thread on risk or not of transmission between 2 people both on meds, not about 1 who is (or says so...) and 1 who's not. Sorry if this was unclear.

The Swiss statement doesn't say transmission from people on meds will never happen, just that it's very, very unlikely when certain conditions are met. 

Like it is for oral sex.

Like it is when using condoms.

Some people's gonna be surprised.

Clearly you have been surprised, and I sorry for that, especially the Sustiva resistance.

This need not mean your treatment will be less effective.

For one, these NNRTIs are a sort list of 4 drugs (out out 20+): 1 is never really used these days and 1 is new and not always affected by mutations that cause resistance to Sustiva.

For two, there's plenty more drugs that will work.

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

Offline komnaes

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Re: transmitting hiv on meds
« Reply #16 on: April 08, 2009, 09:41:41 PM »
Name:     Miss Philicia
Posts:    9,664 (9.821 per day)
Date Registered:    July 29, 2006, 05:37:06 pm


"Miss Philicia" don't post for nothing

At least most of his posts are short and readable and not 14 pages reports cut-and-pasted from medical journals.
Aug 07 Diagnosed
Oct 07 CD4=446(19%) Feb 08 CD4=421(19%)
Jun 08 CD4=325(22%) Jul 08 CD4=301(18%)
Sep 08 CD4=257/VL=75,000 Oct 08 CD4=347(16%)
Dec 08 CD4=270(16%)
Jan 09 CD4=246(13%)/VL=10,000
Feb 09 CD4=233(15%)/VL=13,000
Started meds Sustiva/Epzicom
May 09 CD4=333(24%)/VL=650
Aug 09 CD4=346(24%)/VL=UD
Nov 09 CD4=437(26%)/VL=UD
Feb 10 CD4=471(31%)/VL=UD
June 10 CD4=517 (28%)/VL=UD
Sept 10 CD4=687 (31%)/VL=UD
Jan 11 CD4=557 (30%)/VL=UD
April 11 CD4=569 (32%)/VL=UD
Switched to Epizcom, Reyataz and Norvir
(Interrupted for 2 months with only Epizcom & Reyataz)
July 11 CD=520 (28%)/VL=UD
Oct 11 CD=771 (31%)/VL=UD(<30)
April 12 CD=609 (28%)/VL=UD(<20)
Aug 12 CD=657 (29%)/VL=UD(<20)
Dec 12 CD=532 (31%)/VL=UD(<20)
May 13 CD=567 (31%)/VL=UD(<20)
Jan 14 CD=521 (21%)/VL=UD(<50)

Offline John2038

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Re: transmitting hiv on meds
« Reply #17 on: April 09, 2009, 04:43:37 AM »
At least most of his posts are short and readable and not 14 pages reports cut-and-pasted from medical journals.

How about your posts   :) ?

http://forums.poz.com/index.php?topic=22882.msg291222#msg291222
http://forums.poz.com/index.php?topic=26458.msg328890#msg328890
http://forums.poz.com/index.php?topic=5747.msg328174#msg328174
http://forums.poz.com/index.php?topic=24709.msg311233#msg311233
...

EDIT
I agree that my post was too long (causing the thread to become difficult).
So I made it shorter.
« Last Edit: April 09, 2009, 05:22:28 AM by John2038 »

Offline komnaes

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Re: transmitting hiv on meds
« Reply #18 on: April 09, 2009, 05:52:40 AM »
Your point?

Confusing photos of drag queens with medical journal articles?

Or are they the same thing to do you?
Aug 07 Diagnosed
Oct 07 CD4=446(19%) Feb 08 CD4=421(19%)
Jun 08 CD4=325(22%) Jul 08 CD4=301(18%)
Sep 08 CD4=257/VL=75,000 Oct 08 CD4=347(16%)
Dec 08 CD4=270(16%)
Jan 09 CD4=246(13%)/VL=10,000
Feb 09 CD4=233(15%)/VL=13,000
Started meds Sustiva/Epzicom
May 09 CD4=333(24%)/VL=650
Aug 09 CD4=346(24%)/VL=UD
Nov 09 CD4=437(26%)/VL=UD
Feb 10 CD4=471(31%)/VL=UD
June 10 CD4=517 (28%)/VL=UD
Sept 10 CD4=687 (31%)/VL=UD
Jan 11 CD4=557 (30%)/VL=UD
April 11 CD4=569 (32%)/VL=UD
Switched to Epizcom, Reyataz and Norvir
(Interrupted for 2 months with only Epizcom & Reyataz)
July 11 CD=520 (28%)/VL=UD
Oct 11 CD=771 (31%)/VL=UD(<30)
April 12 CD=609 (28%)/VL=UD(<20)
Aug 12 CD=657 (29%)/VL=UD(<20)
Dec 12 CD=532 (31%)/VL=UD(<20)
May 13 CD=567 (31%)/VL=UD(<20)
Jan 14 CD=521 (21%)/VL=UD(<50)

Offline Peter Staley

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Re: transmitting hiv on meds
« Reply #19 on: April 09, 2009, 07:02:36 AM »
John & Shaun -- end this flame war now -- that's a warning.  Please stick to the thread subject only.

Peter

Offline jportland

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Re: transmitting hiv on meds
« Reply #20 on: April 10, 2009, 07:17:28 AM »
Thanks again to all who responded.  I especially found Ann, Newt, and John2038's responses informative. 
                As far as the fact that I was infected with a drug resistant strain and knowing there are plenty of drugs for it I am aware of that and fine and healthy and not to concerned that I am resistant to the class that I am at this point. And now that I know so much more about hiv but at first when you are first infected and don't know about hiv and are told you have a resistant virus on top of it it is quite a big deal at the time and rather upsettting.  I was infected almost 7 years ago and have gotten to understand things more and am ok with things and more knowledgeable. 
         So I was not suprised when I got it, more or less suprised when this study came out looking back in retrospect to WHEN I was infected now gave me questions and such because of this study and also what I knew or thought I knew about the person that infected me.  Obviously he wasn't undetectable and or lapsed in taking his drugs and also it was my own fault for not having protected sex with him after a month and such.
               It was just interesting to me as i thought this study pertained to me in a way and I guess maybe it does not in the way that I thought it did afterall.  Good to know. And that clears it all up for me:)  Have a great day until next time....
« Last Edit: April 10, 2009, 07:23:07 AM by jportland »
2001 tested neg
8/2002  seroconvert
9/2002 Tested Poz
No Meds
2/2003 302/25% 76K
9/2004 463/23% 14K
8/2005 342/22% 19K
7/2006 381/29% 24K
3/2007 386/34% 34K
3/2008 230/21% 269K
3/2008  Started Meds
7/2008 485/23% VL 140
9/2008 465/24% VL Undetectable
1/2010 581/29% VL Undectectable

Offline Ann

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Re: transmitting hiv on meds
« Reply #21 on: April 10, 2009, 07:46:08 AM »
J, you're welcome - I'm happy I could be of some assistance. Anytime - that's what we're here for.

Take care and be good to yourself.

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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