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Author Topic: Spreading HIV while being undetectable???  (Read 4727 times)

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Offline stevevaboy

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Spreading HIV while being undetectable???
« on: February 23, 2012, 01:01:44 PM »
I've been hearing and reading stories from various publications about HIV being practically non-transmittable from someone who is POZ, but has their viral load undetectable by way of treatments (meds). What's the latest on this and are there known cases of HIV being transmitted in this fashion??
;0

Offline Rhaegar

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Re: Spreading HIV while being undetectable???
« Reply #1 on: February 23, 2012, 01:50:56 PM »
Having your viral load down to undetectable greatly reduces the risk of transmission of the virus to another person.  It doesn't mean there is no risk.  My take on it is that a single result is just that.  If you get blood tests done every couple of months, it only measures a snapshot at that moment.  You very well could have had a fluctuating viral load in those few months and not been aware.  At least, that's my thinking.
05/19/2011: Diagnosed.  CD4 159   VL 284,000.
04/29/2013:  CD4 789,   VL <20

Offline buginme2

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Re: Spreading HIV while being undetectable???
« Reply #2 on: February 23, 2012, 01:57:02 PM »
The HPTN 052 clinical trial tested 1763 serodiscordant heterosexual couples. They were seperated into an early treatment group and a delayed treatment group.  There was a reduction of HIV transmissions of 96% when the positive partner received antiretroviral therapy.

http://www.nejm.org/doi/full/10.1056/NEJMoa1105243

One thing to note>>these studies have only been completed in hetersexual couples.  They have not been done in homosexual couples.  Therefore, if you are having anal sex, the benefit of treatment is unkown.


Offline leatherman

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Re: Spreading HIV while being undetectable???
« Reply #3 on: February 23, 2012, 02:31:40 PM »
You very well could have had a fluctuating viral load in those few months and not been aware.
being on successful HAART (sustaining UD) for a certain amount of time (at least 6 mos. to a yr.) really means a UN-fluctuating viral load.  ;)

Of course, this territory is similar to the super-infection/re-infection issues. IF transmitting HIV was a high risk between partners we would already be seeing many cases of poz-on-poz re-infections (as many people sero-sort and continue to have unprotected sex and it would be noticed by failing HAART regimens) and neg partners in sero-discordant couple turning positive. However almost all data at this time points to only people with no treatment or un-successful treatment as having issues with transmission and re-infection.
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Offline Andy Velez

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Re: Spreading HIV while being undetectable???
« Reply #4 on: February 23, 2012, 02:43:22 PM »
The fact that 052 was only done with heterosexual couples leaves a big question mark unanswered regarding gay or bi couples.

But even if that lapse gets corrected with another successful trial, undetectable definitely doesn't mean elimination of all risk as Rhaegar has accurately pointed out.
Way lower risk is not the same as no risk.
Andy Velez

Offline Hellraiser

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Re: Spreading HIV while being undetectable???
« Reply #5 on: February 23, 2012, 03:37:51 PM »
For a trial to be performed on gay men you would need a large cross section of gay men who were monogamous and in a relationship for an extended period of time.  This might prove quite difficult.

Offline Rev. Moon

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Re: Spreading HIV while being undetectable???
« Reply #6 on: February 23, 2012, 03:43:48 PM »
This might prove quite difficult.

How so?  This is the sort of comment that the retardicans use to support their opposition to sodomite marriage.  Them deviants can't even be faithful to one another.
"I have tried hard--but life is difficult, and I am a very useless person. I can hardly be said to have an independent existence. I was just a screw or a cog in the great machine I called life, and when I dropped out of it I found I was of no use anywhere else."

Offline Hellraiser

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Re: Spreading HIV while being undetectable???
« Reply #7 on: February 23, 2012, 03:44:50 PM »
How so?  This is the sort of comment that the retardicans use to support their opposition to sodomite marriage.  Them deviants can't even be faithful to one another.

Lighten up, it was a joke about a stereotype.

Offline elf

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Re: Spreading HIV while being undetectable???
« Reply #8 on: February 25, 2012, 09:00:49 PM »
I haven't been undetectable for a year now (well ever since they started using the most sensitive method here). My viral load fluctuates between 7 and 22, but no it's never zero (undetectable).
Let's have a Kiki!

Offline leatherman

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Re: Spreading HIV while being undetectable???
« Reply #9 on: February 25, 2012, 09:07:36 PM »
My viral load fluctuates between 7 and 22, but no it's never zero (undetectable).
for many years under 400 was called "undetectable". Then under 200. Now depending on the test the lab does, under 100, under 40 or under 20 is called "undetectable". (The lab my ASO uses only measures as low as 20 right now.) Since there is no test that measures 0, You can clearly say right now that your vl is undetectable ;)
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Offline mecch

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Re: Spreading HIV while being undetectable???
« Reply #10 on: February 26, 2012, 11:29:16 AM »
I've been hearing and reading stories from various publications about HIV being practically non-transmittable from someone who is POZ, but has their viral load undetectable by way of treatments (meds). What's the latest on this and are there known cases of HIV being transmitted in this fashion??

There was an article in the french language gay monthly in Switzerland updating the Swiss Statement a few years on...
http://www.aidsmap.com/The-Swiss-statement/page/1322904/

And asking why there can be no official announcements for gays.  And we all know the various reasons, as mentioned in posts above.

And in this article a doctor said the estimated risk of transmission was 1 in 100,000 when the HIV+ is undetectable and NO STDs. 


ďFrom each, according to his ability; to each, according to his needĒ 1875 K Marx

Offline spacebarsux

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Re: Spreading HIV while being undetectable???
« Reply #11 on: February 26, 2012, 12:01:33 PM »
are there known cases of HIV being transmitted in this fashion??

Yes, there have been cases where transmission has occurred despite undetectable VL.

Link:- http://www.aidsmap.com/Studies-homosexual-transmission/page/1322867/
Infected-  2005 or early 2006; Diagnosed- Jan 28th, 2011; Feb '11- CD4 754 @34%, VL- 39K; July '11- CD4 907@26%,  VL-81K; Feb '12- CD4 713 @31%, VL- 41K, Nov '12- CD4- 827@31%

Offline Hellraiser

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Re: Spreading HIV while being undetectable???
« Reply #12 on: February 26, 2012, 12:12:47 PM »
Yes, there have been cases where transmission has occurred despite undetectable VL.

Link:- http://www.aidsmap.com/Studies-homosexual-transmission/page/1322867/

"The investigators used clinical and epidemiological information to identify the factors involved in new HIV infections in gay men and, by performing phylogenetic analysis on the HIV from 859 individuals, 41 'likely transmitters' were identified, 29 (70%) of whom had never taken HIV treatment and nine of whom had interrupted their treatment at the time of transmission."

Offline spacebarsux

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Re: Spreading HIV while being undetectable???
« Reply #13 on: February 26, 2012, 12:16:19 PM »
"Taking HIV treatment was associated with a 96% reduction in the risk of HIV transmission; of the three transmissions on treatment seen during 3556 person-years of follow-up, one is thought to have originated in an individual with an undetectable viral load. No further details are available.

This is not the first recorded case of HIV transmission during sex between men where the infected partner has an undetectable viral load, however. In a case report from Germany, published in August 2008, and confirmed by phylogenetic analysis, a gay man who had maintained an undetectable viral load on treatment since 2000 apparently infected his partner between 2002 and 2004 after reporting unprotected anal intercourse on a number of occasions. Neither partner reported a sexually transmitted infection and both reported that their relationship was monogamous."


As I understand it, the risk is one is several thousand or lower but it is not zero risk.
« Last Edit: February 26, 2012, 12:18:15 PM by spacebarsux »
Infected-  2005 or early 2006; Diagnosed- Jan 28th, 2011; Feb '11- CD4 754 @34%, VL- 39K; July '11- CD4 907@26%,  VL-81K; Feb '12- CD4 713 @31%, VL- 41K, Nov '12- CD4- 827@31%

Offline Hellraiser

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Re: Spreading HIV while being undetectable???
« Reply #14 on: February 26, 2012, 12:21:13 PM »
"Taking HIV treatment was associated with a 96% reduction in the risk of HIV transmission; of the three transmissions on treatment seen during 3556 person-years of follow-up, one is thought to have originated in an individual with an undetectable viral load. No further details are available.

This is not the first recorded case of HIV transmission during sex between men where the infected partner has an undetectable viral load, however. In a case report from Germany, published in August 2008, and confirmed by phylogenetic analysis, a gay man who had maintained an undetectable viral load on treatment since 2000 apparently infected his partner between 2002 and 2004 after reporting unprotected anal intercourse on a number of occasions. Neither partner reported a sexually transmitted infection and both reported that their relationship was monogamous."

As I understand it, the risk is one is several thousand or lower but it is not zero risk.

You're right it's not zero (or 100% immunity) but in science almost nothing is.  That would be akin to the difference between scientific theory and law.  I would be more inclined to believe that the guys who did transmit the virus actually shared blood rather than sexually transmitted the virus.  A 1 in 1000 transmission would be the exception not the rule.

Offline spacebarsux

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Re: Spreading HIV while being undetectable???
« Reply #15 on: February 26, 2012, 12:46:57 PM »
  A 1 in 1000 transmission would be the exception not the rule.

True that. But I'd wrap up rather than risk being 'that one', however remote the possibility.

Especially if I lived in France (after reading that other thread).
« Last Edit: February 26, 2012, 12:48:46 PM by spacebarsux »
Infected-  2005 or early 2006; Diagnosed- Jan 28th, 2011; Feb '11- CD4 754 @34%, VL- 39K; July '11- CD4 907@26%,  VL-81K; Feb '12- CD4 713 @31%, VL- 41K, Nov '12- CD4- 827@31%

Offline Hellraiser

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Re: Spreading HIV while being undetectable???
« Reply #16 on: February 26, 2012, 01:03:27 PM »
True that. But I'd wrap up rather than risk being 'that one', however remote the possibility.

Especially if I lived in France (after reading that other thread).

None of us wants to be the one to spread this virus any further.

Offline Miss Philicia

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Re: Spreading HIV while being undetectable???
« Reply #17 on: February 26, 2012, 01:18:59 PM »
None of us wants to be the one to spread this virus any further.

Not from what I've heard -- I think you're all Poz Monsters.
"Iíve slept with enough men to know that Iím not gay"

Offline jkinatl2

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Re: Spreading HIV while being undetectable???
« Reply #18 on: February 26, 2012, 10:51:45 PM »
True that. But I'd wrap up rather than risk being 'that one', however remote the possibility.

Especially if I lived in France (after reading that other thread).

Well, this is why we call every single serodiscordant relationship with a sexual component "negotiated risk."

Some refuse to take that risk at all. Some make other choices.

I have had three long term relationships and probably more short term ones than there are words I can spell. And never, not ever, have I spread my virus to anyone else.

This is despite YEARS of being off therapy, with a viral load in the millions. Despite negotiated safer sex that often included oral sex in both directions. Despite the occasional slip, the occasional condom break (after which PEP was never sought). Granted, I am older now, and my boundaries have tightened up a lot. And there are options now that there simply werent before, from Prep to my own amazing regimen that I take semi-religiously.

Thing is, I know my personal experience is not Data. I rarely share it here because it is often, however, ammunition.  But in cases like this, it is important to know that a binary view of life with HIV is not usually globally applicable.

I am not ashamed of my choices, and they have served, and continue to serve me well.

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

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Offline surf18

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Re: Spreading HIV while being undetectable???
« Reply #19 on: February 27, 2012, 07:29:43 PM »
Wouldn't it make a difference if the Poz guy was the bottom?

Offline jkinatl2

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Re: Spreading HIV while being undetectable???
« Reply #20 on: February 27, 2012, 08:19:47 PM »
Wouldn't it make a difference if the Poz guy was the bottom?

Given the caveat that each sexual situation and each person is unique, you are correct. The risk for transmission is generally far greater from top to bottom, rather than the other way around.

That having been said, we have several members here who are certain that they got HIV from topping, as well as several male members who got HIV from heterosexual sex.  As both parties are in the distinct minority on these boards (and judging from HIV support in most first world countries, this seems to be the case outside the boards as well) it stands to reason that an UD viral load would further minimize the possibility of transmission.

A minimized risk is, of course, still a risk. That's where the "negotiated" part of negotiated safer sex enters the picture.

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

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Offline PositivelyMotivated

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Re: Spreading HIV while being undetectable???
« Reply #21 on: March 04, 2012, 06:43:07 AM »
i dont know how much can be read into this but i was infected heterosexually/vaginally sometime in 10 encounters by a girl who was on ARVs for 8 years , atripla for the past 2 ... of those 10 encounters i actually believe it to be in the first 5 going by the time frame of the initial flu-like symptoms ...

as i said its hard to pick what to believe in this  situation being as i wasnt privy to her labworks but one could probably reason that if she wasnt UD she was at the very least very low on her VL ... all said - vaginal sex , penetrative partner , other party on ARVs - i would reason it to still be very risky business ...
Infected 8/15/11
3/1/12 CD4 398 VL 35k

Offline Hellraiser

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Re: Spreading HIV while being undetectable???
« Reply #22 on: March 04, 2012, 04:38:17 PM »
i dont know how much can be read into this but i was infected heterosexually/vaginally sometime in 10 encounters by a girl who was on ARVs for 8 years , atripla for the past 2 ... of those 10 encounters i actually believe it to be in the first 5 going by the time frame of the initial flu-like symptoms ...

as i said its hard to pick what to believe in this  situation being as i wasnt privy to her labworks but one could probably reason that if she wasnt UD she was at the very least very low on her VL ... all said - vaginal sex , penetrative partner , other party on ARVs - i would reason it to still be very risky business ...

You never saw her numbers, do you even know for sure she was taking her meds?  How do you know she was on meds for 8 years?

Offline newt

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Re: Spreading HIV while being undetectable???
« Reply #23 on: March 04, 2012, 06:21:05 PM »
I conclude anal/vaginal sex with people on ARVs is prob like oral sex for blokes with blokes in general (ie not considering meds), a minority but real transmission route, improbable but possible on a personal level given the other variables, marginal on a population level since it is less than a few % of cases.

This observation negates nether the small risk nor the great protection offered by having sex with someone on ARVs for more than 6 months with a low viral load.

- matt
« Last Edit: March 04, 2012, 06:23:26 PM by newt »
"The object is to be a well patient, not a good patient"

Offline PositivelyMotivated

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Re: Spreading HIV while being undetectable???
« Reply #24 on: March 05, 2012, 03:15:08 AM »
@ hellraiser ... that is a good point ... i do know she was at least prescribed meds for 8 years through info from her family ... as for her doing so responsibly i cant say for sure ... one would hope that 8  years of ARV treatment would make one adhere to treatment plans but i guess you never know unless youre there ..
Infected 8/15/11
3/1/12 CD4 398 VL 35k

Offline jkinatl2

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Re: Spreading HIV while being undetectable???
« Reply #25 on: March 05, 2012, 03:38:29 AM »
@ hellraiser ... that is a good point ... i do know she was at least prescribed meds for 8 years through info from her family ... as for her doing so responsibly i cant say for sure ... one would hope that 8  years of ARV treatment would make one adhere to treatment plans but i guess you never know unless youre there ..


I've been on meds since 1993. There have been prolonged periods of time where I was off of them, with a huge viral load and cd4 cells in the single digits. Being prescribed meds (and even being aware of the facts regarding HIV/AIDS)  is, unfortunately, not the same as actually taking them.



"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

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