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Author Topic: HIV transmission to HIV+, UD patient  (Read 2044 times)

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Offline MadisonTeddy

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HIV transmission to HIV+, UD patient
« on: March 22, 2014, 11:02:04 AM »
Considering the new studies, am I to believe that a person who is HIV+ and UD has no chance of contracting a different strain of HIV from unprotected sex??

Offline YellowFever

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Re: HIV transmission to HIV+, UD patient
« Reply #1 on: March 22, 2014, 11:31:24 AM »
No the studies conclude the reverse, an HIV+ person with VL=UD has at most 4% chance (possibly 0%) of transmitting the virus to others. I don't think it correlates to the risk of receiving a different strain of virus (say from a recently seroconverted, highly infectious, super ignorant barebacker). But it should be possible to conclude that two HIV+ persons with VL=UD have no chance of transmitting their own strains of HIV to each other.

*PS: Before the flame war starts, 'ignorant' refers to 'not knowing one's HIV status', NOT 'not knowing the risks associated with barebacking..'
08/2010 HIV- 08/2012 HIV+
10/2012 CD4 415(15%)
04/2013 CD4 457(15%)
10/2013 CD4 520 (20%) VL 650 (wtf?)
02/2014 CD4 410(20%) VL 390 (yay!)
08/2014 CD4 580(?%)

Offline AusShep

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Re: HIV transmission to HIV+, UD patient
« Reply #2 on: March 22, 2014, 11:35:47 AM »
I think you have your logic backwards... Just because an UD seems not to pass the virus to others, doesn't mean he's immune to receiving HIV from someone with a high viral load.

I think all the super virus cross infection stuff has been shown to be bunk, and your meds would likely suppress anything new thrown into the mix. 

Maybe someone with more knowledge into the research would know if strains resistant to your meds could be a problem and get into your reservoirs, but since people aren't dropping dead left and right from some super AIDS resistant to everything, I tend to doubt it is a big concern.

Offline Grasshopper

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Re: HIV transmission to HIV+, UD patient
« Reply #3 on: March 22, 2014, 01:19:37 PM »


I think all the super virus cross infection stuff has been shown to be bunk, and your meds would likely suppress anything new thrown into the mix. 

......., but since people aren't dropping dead left and right from some super AIDS resistant to everything, I tend to doubt it is a big concern.

 ;)

Offline MadisonTeddy

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Re: HIV transmission to HIV+, UD patient
« Reply #4 on: March 23, 2014, 09:51:40 AM »
"No the studies conclude the reverse, an HIV+ person with VL=UD has at most 4% chance (possibly 0%) of transmitting the virus to others."

Doesn't the 2 year PARTNER story debunk that 4% statement?? I am led to believe that it is a 0 {zero} percent chance of passing HIV to a HIV- person if my VL is UD...

Offline RapidRod

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Re: HIV transmission to HIV+, UD patient
« Reply #5 on: March 23, 2014, 09:57:52 AM »
"No the studies conclude the reverse, an HIV+ person with VL=UD has at most 4% chance (possibly 0%) of transmitting the virus to others."

Doesn't the 2 year PARTNER story debunk that 4% statement?? I am led to believe that it is a 0 {zero} percent chance of passing HIV to a HIV- person if my VL is UD...
Have you have had a semen VL test done? My serum VL is UD but my semen VL is not.

Offline friskyguy

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Re: HIV transmission to HIV+, UD patient
« Reply #6 on: March 23, 2014, 10:17:15 AM »
i recall reading that in 'some people' viral load is transitory and detectable in semen (although relatively low) while an STD is present in their urinary tract despite being UD in plasma.

however despite a detectable viral load in semen i still have not read anywhere that this will mean a possible hiv transmission.....maybe cause the viral load in semen in these people is relatively low?
Sero converted Sept '10 / Confirmed + Dec '10
Jan '11, VL 9,500 / CD4 482 (32%)
Feb '11, VL 5,800 / CD4 680 (37%)
start Atripla
Mch '11, VL UD / CD4 700 (42%)
Jun  '11, VL UD / CD4 750 (43%)
swap to Kivexa and Efav. due to osteopenia diag. (DEXA) / kidney issues ( decline in eGFR to 77 )
start supplements - Vit D3 / Omega 3 / multivitamin / mini aspirin
Dec '11,  VL UD <20 /  CD4 670 (49%)  / CD4:CD8 = 1.4
all labs now within normal ranges
Mch '12,  VL UD / CD4 600 (51%)
Sep '12,  VL UD / CD4 810 (51%)
Mch '13   VL UD / CD4 965 (56%)
Sep '13   VL UD / CD4 (not taken)
Dec '13   VL UD / CD4 901 (35%) / CD4:CD8 = 1.1  /  eGFR > 100

Offline AusShep

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Re: HIV transmission to HIV+, UD patient
« Reply #7 on: March 23, 2014, 10:29:40 AM »
"No the studies conclude the reverse, an HIV+ person with VL=UD has at most 4% chance (possibly 0%) of transmitting the virus to others."

Doesn't the 2 year PARTNER story debunk that 4% statement?? I am led to believe that it is a 0 {zero} percent chance of passing HIV to a HIV- person if my VL is UD...

No, the PARTNER study is where the max 4% transmission per year for receptive condomless sex comes from.  This was based on the PARTNER data extrapolated to a high confidence level.  Basically, there isn't enough data to say absolutely 0% risk, and it's unlikely they'll ever say it's absolutely impossible.   

Offline MadisonTeddy

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Re: HIV transmission to HIV+, UD patient
« Reply #8 on: March 23, 2014, 10:48:05 AM »
"No, the PARTNER study is where the max 4% transmission per year for receptive condomless sex comes from.  This was based on the PARTNER data extrapolated to a high confidence level.  Basically, there isn't enough data to say absolutely 0% risk, and it's unlikely they'll ever say it's absolutely impossible."

But the 4% was a different strain genetically and 38% acknowledged anal sex outside of the relationship thus deducing that the 4% were infected outside the relationship

Offline RapidRod

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Re: HIV transmission to HIV+, UD patient
« Reply #9 on: March 23, 2014, 10:57:51 AM »
"No, the PARTNER study is where the max 4% transmission per year for receptive condomless sex comes from.  This was based on the PARTNER data extrapolated to a high confidence level.  Basically, there isn't enough data to say absolutely 0% risk, and it's unlikely they'll ever say it's absolutely impossible."

But the 4% was a different strain genetically and 38% acknowledged anal sex outside of the relationship thus deducing that the 4% were infected outside the relationship
Is it worth taking the chance of infecting someone else when you know what the hardships are by being infected?

Offline MadisonTeddy

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Re: HIV transmission to HIV+, UD patient
« Reply #10 on: March 23, 2014, 11:01:42 AM »
Rapid Rod.....This thread is not about my needs or my decisions but to educate me better about the transmission of HIV...Please don't be some assumptive.

Offline RapidRod

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Re: HIV transmission to HIV+, UD patient
« Reply #11 on: March 23, 2014, 11:04:30 AM »
Rapid Rod.....This thread is not about my needs or my decisions but to educate me better about the transmission of HIV...Please don't be some assumptive.
It wasn't being an assumptive, it was a question asking you if it would be worth it taking a chance.

Online Jeff G

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Re: HIV transmission to HIV+, UD patient
« Reply #12 on: March 23, 2014, 11:09:37 AM »
Hi Teddy . Undetectable is only part of the equation when you start using percentages .

For instance a person can have syphilis for a long time and not know and when it awakens all bets are off as how infectious a person is who has been previously undetectable .

Its good that we have these conversations because we would not want a person to think that being undetectable is always the end game in risk prevention .

This is why we advise ... You need to be using condoms for anal or vaginal intercourse, every time, no exceptions until such time as you are in a securely monogamous relationship where you have both tested for ALL sexually transmitted infections together.
 

Offline AusShep

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Re: HIV transmission to HIV+, UD patient
« Reply #13 on: March 23, 2014, 11:10:24 AM »
...
But the 4% was a different strain genetically and 38% acknowledged anal sex outside of the relationship thus deducing that the 4% were infected outside the relationship

They threw out the results of those who picked up HIV outside of the relationship.  The theoretical risk we're talking about is still from an UD person to their negative partner in receptive anal sex over the course of a year.

Offline MadisonTeddy

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Re: HIV transmission to HIV+, UD patient
« Reply #14 on: March 23, 2014, 11:39:51 AM »
Rapid Rod....No
Jeff G....I agree

But from our own bloggers I am getting mixed messages..

We are not infectious, or dangerous, or criminals.

    "The main news is that in the PARTNER Study so far there have been no transmissions within couples from a partner with an undetectable viral load, in what was estimated as 16,400 occasions of sex in the gay men and 14,000 in the heterosexuals."


risk
Please read about this newly released study:

AIDSmap: No-one with an undetectable viral load, gay or heterosexual, transmits HIV in first two years of PARTNER study

Offline MadisonTeddy

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Re: HIV transmission to HIV+, UD patient
« Reply #15 on: March 23, 2014, 11:57:02 AM »
I think I have perhaps answered my own question...From Dr. Joel Gallant:

"I thought I already explained it pretty well in my recent discussion of the PARTNER study. In that study, there were no transmissions from a positive partner with an undetectable viral load to a negative partner. In HPTN 052 there was one transmission from a positive partner on ART to a negative partner, but the positive partner’s viral load probably hadn’t been fully suppressed at the time of the transmission.  Therefore, the results of the two studies are consistent: both suggest that the estimated risk of sexual transmission is zero if the positive partner has an undetectable viral load.

For reasons I already discussed, that’s still an estimated risk. It’s hard to prove a negative.  It’s possible that if both studies had been larger, there might have been a transmission.  Still, the results of these two studies are highly reassuring."

Offline YellowFever

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Re: HIV transmission to HIV+, UD patient
« Reply #16 on: March 23, 2014, 03:12:07 PM »
No, the PARTNER study is where the max 4% transmission per year for receptive condomless sex comes from.  This was based on the PARTNER data extrapolated to a high confidence level.  Basically, there isn't enough data to say absolutely 0% risk, and it's unlikely they'll ever say it's absolutely impossible.
Agree with AusShep.
Based on their presentation slides:
http://www.cphiv.dk/portals/0/files/CROI_2014_PARTNER_slides.pdf

The 4% comes from the fact that the study was only a 2 year study but they wanted to extrapolate it to a "10-year within couple risk". I think continued study will tighten the 95% CI
08/2010 HIV- 08/2012 HIV+
10/2012 CD4 415(15%)
04/2013 CD4 457(15%)
10/2013 CD4 520 (20%) VL 650 (wtf?)
02/2014 CD4 410(20%) VL 390 (yay!)
08/2014 CD4 580(?%)

Offline mecch

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Re: HIV transmission to HIV+, UD patient
« Reply #17 on: March 23, 2014, 05:59:07 PM »
Excuse me, i don't really understand this exchange. Half these posts and all the research sited is about HIV transmission to a negative person.

I thought this thread is about the possibility of HIV transmission between pozzies...  Maybe conferring drug resistance.  This is a specific issue and question and I don't see a response yet.
« Last Edit: March 23, 2014, 06:01:22 PM by mecch »
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline RapidRod

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Re: HIV transmission to HIV+, UD patient
« Reply #18 on: March 23, 2014, 06:08:40 PM »
Excuse me, i don't really understand this exchange. Half these posts and all the research sited is about HIV transmission to a negative person.

I thought this thread is about the possibility of HIV transmission between pozzies...  Maybe conferring drug resistance.  This is a specific issue and question and I don't see a response yet.
It was answered you don't do it.

Online zach

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Re: HIV transmission to HIV+, UD patient
« Reply #19 on: March 23, 2014, 06:19:49 PM »
the whole thing of being reinfected with a different strain, superinfection. just as a question not as any sort of behavior justification.... is that real? i don't mean the "it's possible" sort of answer, does it really happen enough to be a legitimate concern?
gonna go up to the mountain, for to find a little peace
looking over the valley, for the beauty i see
out across the hills, forevermore

Offline mecch

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Re: HIV transmission to HIV+, UD patient
« Reply #20 on: March 23, 2014, 06:26:01 PM »
It was answered you don't do it.
OK, thanks, that clarifies it!
“From each, according to his ability; to each, according to his need” 1875 K Marx

Online buginme2

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Re: HIV transmission to HIV+, UD patient
« Reply #21 on: March 23, 2014, 08:26:07 PM »
Reading comprehension seems to have failed in this thread.

Offline absopozilutely

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Re: HIV transmission to HIV+, UD patient
« Reply #22 on: March 24, 2014, 12:02:12 AM »
Lol Zach, you say a legitimate concern like we haven't already played our cards and lost remember were the 1 in 1000.
12/18 Infected
2/4 12:22pm tested POZ via ORAquick
2/19 WB Confirmation
2/4-2/19 VL 104,678 CD4 407
3/2 Genotype back, and Started Complera
4/2-CD4 688 38% and VL 1,600
5/1-CD4 592 42% and VL 336
5/22-CD4 732 31% and VL 109 :( STILL NOT UD!
5/31 Switched to Stribild :( I'll miss you Complera!
6/19 CD4 508 35% and VL UD!!!!! Crying at work like a baby.
9/19 CD4 799 46% VL UD yayyyy

Offline leatherman

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Re: HIV transmission to HIV+, UD patient
« Reply #23 on: March 24, 2014, 12:20:55 AM »
Reading comprehension seems to have failed in this thread.
amen!

An HIV+ UD person does not transmit HIV to another HIV- or HIV+ person
     (Undetectable is the new "negative" in condomless sex)

An HIV+ UD peron cannot be reinfected or superinfected by another HIV+ person
     if that other HIV+ person is UD then of course +transmission is 0%
     if that other HIV+ person has a detectable VL, the UD/medicated status (ie PrEP in fact) of the first person is protection against infection

however other STDs, pregnancy, and/or UTIs can happen with condomless sex :o
leatherman (aka mIkIE)


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

Offline Ann

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Re: HIV transmission to HIV+, UD patient
« Reply #24 on: March 24, 2014, 06:49:25 AM »
I suppose it's worth saying this yet again for the sake of our newbies.

For a start, the term "superinfection" is completely interchangeable with the term "reinfection". It's the same darn thing dressed up with a more frightening word.

The term "superinfection" scares a lot of people because it sounds like some kind of super-strength infection, like Superman is a super-strength man. It's not.

The "super" part of the word is a prefix that means 'one on top of the other', as it does in the word superimposed. It's one infection on top of the other -  one virus "superimposed" on the other. It's usually a resistance type virus on top of a wild-type virus.

It doesn't mean you'll get sicker quicker or anything like that - it would only mean that you might be resistant to a med or sometimes a whole class of med. If my memory serves, Sustiva was the usual culprit in the RARE few cases in which they'd observed superinfection.

Resistance to Sustiva isn't the end of the world these days, we have many more meds and med classes to chose from today. Inconvenient, yes. Game-changing? Slightly. The-end-is-nigh? NO.

The few cases of reinfection I've read about occurred in people who were very newly infected with their first infection - so early that their body had not yet really got to grips with it - when along comes a slightly different strain of hiv that was therefore able to take hold. And they were NOT on meds!

Someone who has been infected for a while and has plenty of hiv antibodies, and/or someone who is on meds just isn't going to end up reinfected. As someone else in this thread mentioned, if it was a huge problem, there would be many of us in this forum facing it. It's not and there aren't.

In my opinion, it's a bogeyman that some medical professionals like to trot out to keep poz people from going bareback with other poz people. Some med pros don't like us to have sex at all, nevermind unprotected sex. That attitude is changing, albeit slowly.

It would be far more reasonable for them to be truthful - that reinfection is RARE as hen's teeth, but if you're gonna BB with your fellow pozzies, make sure you're not getting a dose of the clap or syphilis. Honesty, ya know? Blunt, brutal, HONESTY. ~sigh~
« Last Edit: March 24, 2014, 06:51:36 AM by 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

Online zach

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Re: HIV transmission to HIV+, UD patient
« Reply #25 on: March 24, 2014, 08:19:18 AM »
i don't think i've lost a damn thing, i have a virus, it led to a disease, but i'm still here. i only lose if i die from this.

and thanks ann, i think your explaination backed up my gut feeling, its real, and its real rare
gonna go up to the mountain, for to find a little peace
looking over the valley, for the beauty i see
out across the hills, forevermore

Offline Ann

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Re: HIV transmission to HIV+, UD patient
« Reply #26 on: March 24, 2014, 09:00:58 AM »
i don't think i've lost a damn thing, i have a virus, it led to a disease, but i'm still here. i only lose if i die from this.

I think I've lost my mind - at least I keep forgetting where I put it - but that's already being discussed in another thread. ;)


and thanks ann, i think your explaination backed up my gut feeling, its real, and its real rare

My pleasure! :)
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

Online zach

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Re: HIV transmission to HIV+, UD patient
« Reply #27 on: March 24, 2014, 01:14:41 PM »
we all know you're a loon ann  :o

i've lost my mind a few times, but with that damn chip in it, they call me to come pick it up every time
gonna go up to the mountain, for to find a little peace
looking over the valley, for the beauty i see
out across the hills, forevermore

Offline xinyuan

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Re: HIV transmission to HIV+, UD patient
« Reply #28 on: March 25, 2014, 08:26:01 PM »
*facepalms at thread*

ABOUT FUTURE CHANCE

For any HIV negative human on this planet, the future chance of getting HIV in one's lifetime is NOT exactly 0, while alive.

Who knows what bizarre, far-fetched story may happen. Or usual run of the mill story. But one can still get it. Until they're dead.

Ditto to risk of so-called superinfections.


ABOUT RANGES

In epidemiology, populations are studied through samples.

In an ideal world, every single person in the population gets studied over long time periods for something of interest. But that's expensive, time-consuming, and impractical. In the real world, a sample is used to represent the entire population. It also gets studied over much shorter time periods.

Statisticians have come up with ways to extrapolate such information from such samples. Both to the larger general population and to longer time periods.

However, this leads to a possible range of chance. The fabled 95% confidence interval. Not just a single value.


ABOUT THE PARTNER STUDY

So, yes, the PARTNER researchers found 0 transmissions over a median 2.5 years of follow-up. But based on the sample size for each type of sex, their eggheads are 95% confident for condomless sex that the UPPER limit for HIV transmission risk was:

    For women, vaginal sex with ejaculation: 1.88.
    For men, vaginal sex: about 1.32.
    MSM insertive anal sex: about 1.37.
    MSM receptive anal sex without ejaculation: about 2.5.
    MSM receptive anal sex with ejaculation: 4, translating into a 10-year risk of about 32%.

http://www.thebodypro.com/content/73978/zero-hiv-infections-seen-through-condomless-sex-wh.html

Yes, the lower limit of risk still includes 0.

The study is still ongoing. So, the upper limit will become smaller by 2 ways: longer study period and more sample size (more condomless sex acts).
« Last Edit: March 25, 2014, 08:28:14 PM by xinyuan »

Online zach

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Re: HIV transmission to HIV+, UD patient
« Reply #29 on: March 25, 2014, 09:19:52 PM »
edited to say: shouldn't have said any of that, not nice at all
« Last Edit: March 25, 2014, 09:26:04 PM by zach »
gonna go up to the mountain, for to find a little peace
looking over the valley, for the beauty i see
out across the hills, forevermore

Offline mecch

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Re: HIV transmission to HIV+, UD patient
« Reply #30 on: March 25, 2014, 10:40:46 PM »
xinyuan - why are you going on about HIV transmission to HIV- negative people when that is not the subject of this thread.   >:( :( :o
“From each, according to his ability; to each, according to his need” 1875 K Marx

Online Jeff G

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Re: HIV transmission to HIV+, UD patient
« Reply #31 on: March 25, 2014, 10:50:25 PM »
xinyuan - why are you going on about HIV transmission to HIV- negative people when that is not the subject of this thread.   >:( :( :o

I made the same mistake so my apology to the OP .

 


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