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Author Topic: Undetectable transmission risk  (Read 6268 times)

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Offline buffguy

  • member
  • Posts: 1
Undetectable transmission risk
« on: September 15, 2009, 03:33:11 PM »
I am an HIV+ person with an new partner who is negative. My viral load is undetectable and has been with no variance for 10 years. I have had multiple HIV- partners (five for more than a year) that I practiced unsafe sex with and none of them have ever become positive. The only safe sex practice was for me was not having visible pre-cum and to not cum in my partners. For years I just thought I was lucky and felt so much guilt and worry even though my partners all wanted to take the risk. Then I had a doctor a few years ago tell me that a person who is positive with a viral load under 1000 has never passed the virus onto another person who is negative in any study ever conducted. Is that true? Where can I find these studies? I certainly would be living proof. If this is true, which I suspect it might be, I am just really frustrated to only find worse case scenario information on the Internet and in the general health community lumping all HIV+ people into the same risk category. The other thing that I further question if all of the above has some level of truth, is how two HIV+ undetectable people are a risk to each other if they are not a risk to an negative partner?

Offline Cosmicdancer

  • Member
  • Posts: 138
Re: Undetectable transmission risk
« Reply #1 on: September 15, 2009, 05:43:53 PM »
I think that you may be able to find some studies on this if you do a search on the Poz.com site or do some google searches.  I know I've read summaries of a few studies on here, such as the Swiss study, although that was only a study of heterosexuals, and it found no cases of transmission among monogamous sero-discordant couples where the poz partner was undetectable for over 6 months and had no other active std's.  (I've always wondered what that means in practice given that many people, regardless of HIV status, have herpes, hpv, or epstein-barr).  There was a French study that found that up to 5% of people with no detectable HIV in their blood did have detectable HIV in their semen. 

I also read a summary of a study of sero-discordant couples in sub-Saharan Africa a few months ago.  It contrasted transmission rates among partners where the poz partner was on ARVs with those who are not on ARVs.  As I recall, during the 18 month study, about 20% of people not in treatment transmitted HIV to their partner, wheras only about 2% of partners of Poz people (4 out of about 200 people) sero-converted during the study.  It's not clear from the study if they got HIV from their partner or from someone outside the relationship.  These summaries never give enough information.  Still the risk was much lower.  I believe I saved the link on my other computer.  If I find it, I'll send it later. 

I wish studies of gay men would be done, but I suspect no study with government funding is going to be done on this topic despite the fact that this is a major issue to us.  I've been undetectable for about a year and a half, and I sometimes have unprotected sex (but only when I bottom) with a regular partner who knows my status.  He's aware there is a small risk.  He continues to test negative.  I also feel guilty about putting him at risk, however small.

It would be nice to have more than just anecdotal evidence on this.  Unless couples are monogamous, or the negative partner is always safe with other partners, it will be hard to draw any conclusions even if the negative partner seroconverts.
Summer, 2007 - &$#@?
November, 2007 - Tested poz, 300,000 vl, 560 cd4
Feb, 2008 - 57,000 vl, 520 cd4, started Atripla
June, 2008 - undetectable, 612 cd4
January, 2009 - undetectable, 670 cd4
May, 2009 - undetectable, 593 cd4
Sept, 2009 - 83 vl, 763 cd4, 34%
Dec, 2009 - undetectable, 889 cd4, 32%
April, 2010 - undetectable, 860 cd4, 31%
October, 2010 - undetectable, 800 cd4, 38%
April, 2011 - undetectable, t-cell test not done
October, 2011 - undetectable
April, 2012 - undetectable, 850 cd4, 39%
November, 2012 - undetectable, 901 cd4, 41%
April, 2013 - undetectable, 846 cd4, 36%
October, 2013 - undetectable

Offline veritas

  • Member
  • Posts: 1,408
Re: Undetectable transmission risk
« Reply #2 on: September 15, 2009, 05:53:47 PM »

Offline NYCguy

  • Member
  • Posts: 180
Re: Undetectable transmission risk
« Reply #3 on: September 15, 2009, 06:38:42 PM »
thank you for that Veritas.  The risk to others + superinfection risk are two issues I think about often and continuously am shifting my views on, which of course affects when and how to disclose to a partner and what is acceptable behavior with or without disclosure.  It's all such a complicated, ethical morass!  But reading these studies really does impact my decision-making process and I'm quite pleasantly surprised that the CDC published such a thorough and relatively unbiased summery of these issues.

As for superinfection, I read a study maybe 2 years ago, that found that superinfection has never been documented in persons on effective ART or after 3 years of infection, with or without ART, implying that once 'chronic' phase is entered, superinfection is resisted. The CDC-referenced African study refutes the 3-years theory, but I have to admit that, like many others, now that I'm on the meds I basically don't worry a hoot about getting reinfected and have generally dispensed with condom use when a top is comfortable with that - when topping, I use a condom unless I'm sure the bottom is poz.  Ok, there have been exceptions...but I'm only human.  Operating this way does minimize the guilt factor, but admittedly doesn't eliminate it entirely. 

11/9/06 = #$%^&!
sometime early Dec 2006:
CD4 530 20%/VL >250,000 (&*$$%!!)
started Reyataz300mg/Norvir/Truvada 12-27-06.
1/30/07 CD4 540 30%/VL <400
4/07 CD4 600+ 33%/VL <50
6/9/07 CD4 720 37%/VL <50
10/15/07 CD4 891 (!) %? VL <50
1/2010 CD4 599 (37%) VL<50 (drop due to acute HCV)
9/2010 - looks like HCV is gone for good! And I'm finally drinking again, thank GOD
2013 - considering a switch to Stribild. but I love my Kidneys (but I hate farting all the time!)...
June 2013 - switched to Stribild.  so far so good...

Offline NYCguy

  • Member
  • Posts: 180
Re: Undetectable transmission risk
« Reply #4 on: September 15, 2009, 06:45:57 PM »
I should also add that, again regarding superinfection - it has not turned out to result in the disastrous, untreatable, fast-acting super-virus that everyone was freaking out about just a few years ago.  In general, it means that your med options might be somewhat more limited, or even nothing at all.  I'm not saying it's not a big deal and shouldn't be avoided, just that a few years down the road post-discovery of it's existence,  it turns out not to be such a huge deal and isn't worth excessive paranoia. 
11/9/06 = #$%^&!
sometime early Dec 2006:
CD4 530 20%/VL >250,000 (&*$$%!!)
started Reyataz300mg/Norvir/Truvada 12-27-06.
1/30/07 CD4 540 30%/VL <400
4/07 CD4 600+ 33%/VL <50
6/9/07 CD4 720 37%/VL <50
10/15/07 CD4 891 (!) %? VL <50
1/2010 CD4 599 (37%) VL<50 (drop due to acute HCV)
9/2010 - looks like HCV is gone for good! And I'm finally drinking again, thank GOD
2013 - considering a switch to Stribild. but I love my Kidneys (but I hate farting all the time!)...
June 2013 - switched to Stribild.  so far so good...

Offline PRMike

  • Member
  • Posts: 175
Re: Undetectable transmission risk
« Reply #5 on: September 17, 2009, 08:15:20 AM »
Hi I have been Poz for 29 yrs and I was married for 23 of those 29  and thank GOD my ex-wife never came up positive, I must say that we at many times did not use protection, so I always wondered if I was just a carrier ??? I do use protection when ever possible but then again i'm hardly  having any sex lately... ok I hope you find the answers your looking for as always your friend Mike
PRMike

Offline freaky_dream

  • Member
  • Posts: 132
  • mmm
Re: Undetectable transmission risk
« Reply #6 on: September 18, 2009, 02:15:56 AM »
The gist of what most research is stating is that the virus in your balls is different then that in your blood. They still aren't sure if the meds are able to penetrate our sugar lumps and if they do, does it significagntly effect the viral load.

Offline NYCguy

  • Member
  • Posts: 180
Re: Undetectable transmission risk
« Reply #7 on: September 23, 2009, 03:23:04 PM »
Quote
The gist of what most research is stating is that the virus in your balls is different then that in your blood. They still aren't sure if the meds are able to penetrate our sugar lumps and if they do, does it significagntly effect the viral load.
Yep, I think that says it in a nutshell.  Add to it that is has definitely been shown that effective ARV treatment significantly reduces risk and I think that's about as close to an answer as we can come right now.
11/9/06 = #$%^&!
sometime early Dec 2006:
CD4 530 20%/VL >250,000 (&*$$%!!)
started Reyataz300mg/Norvir/Truvada 12-27-06.
1/30/07 CD4 540 30%/VL <400
4/07 CD4 600+ 33%/VL <50
6/9/07 CD4 720 37%/VL <50
10/15/07 CD4 891 (!) %? VL <50
1/2010 CD4 599 (37%) VL<50 (drop due to acute HCV)
9/2010 - looks like HCV is gone for good! And I'm finally drinking again, thank GOD
2013 - considering a switch to Stribild. but I love my Kidneys (but I hate farting all the time!)...
June 2013 - switched to Stribild.  so far so good...

 


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