Can you pass on virus to negative partner if viral load is undetectable?

[jm1953]

Hey Members:

A friend recently told me that he read it's o.k to have unprotected sex if your viral load is undetectable.  He said he read about it in a reliable publication.  I said I don't think so, but now he is having unsafe sex with a partner who is negative. 

I'm not sure where exactly he got this information, but I was always under the impression you can still pass on the virus even when you have normal CD4's, like in his case above 1000, and undetectable viral load.  His partner is aware of his status so that poses another question.  Since his partner knows he is HIV+ and is willingly having sex with him, who is really the responsible party here?

I know a few partners where one is HIV+ and the other negative, and not getting into specifics, years have passed and the negative partner is still negative.

What's the scoop as I would like to prove my friend wrong in his assumption.  I know there is literature out there about this, but would like your input and possible links to refer to.

As usual thanks,

jm1953

[GSOgymrat]

Let's say hypothetically that undetectable means not infectious. How does your friend know he has an undetectable viral load on any given day? I've had "blips" where my viral load was undetectable, then detectable and then dropped back to undetectable while on the same medication regimen.

[leatherman]

my two cents:
this is probably just like the hetero serodiscordant couples that choose to have unprotected sex to have a child. I still think it's like playing with fire. and the partner? when he gets burned and ends up infected with a terminal disease he better not start crying about it. 

[Inchlingblue]

If someone is undetectable it means they are less infectious but not 100%.

There was a Swiss study that found no transmission among serodiscordant couples if the HIV+ partner was undetectable for at least six months and remained adherent to meds. But there was another study that found detectable levels of HIV in the semen of men who were undetectable in the plasma.

LINKS:

http://www.hivandhepatitis.com/recent/2008/020508_a.html

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

[edfu]

Yes, you can.  Check this out:

http://www.aidsmeds.com/articles/hiv_transmission_semen_1667_15189.shtml

And this:

http://www.aidsmap.com/en/news/167784F9-FD3C-4148-8AB3-F669FE941BB3.asp

[BM]

If someone is undetectable it means they are less infectious but not 100%.

There was a Swiss study that found no transmission among serodiscordant couples if the HIV+ partner was undetectable for at least six months and remained adherent to meds. But there was another study that found detectable levels of HIV in the semen of men who were undetectable in the plasma.

LINKS:



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

Key to the finding in that report is that the couples under study were heterosexual, not homosexual.

[David_CA]

I think a lot of it also depends on what 'role' he's playing.  If he's positive but undetectable and on the receiving end, I'd say it's pretty safe (my opinion only).  What fluid is being exchanged from bottom to the top (assuming no rectal sores and / or abnormal openings on the top's penis)?  If he's a positive top that's undetectable, then there would naturally be some risk.  There used to be a member here (Whizzer) who was in a study to test for HIV in semen.  He's not signed in in over two years due to some BS, which is unfortunate, as I was interested in hearing the results. 

[jm1953]

Thanks for the information you guys!

I believe my friend was going on the assumption that if non-detectable for six months straight it is alright to have unprotected sex with your partner.  And as a side note, I forgot to mention he told me he is versatile in the sack meaning being the top or bottom.

One made a point one's viral load may go up and down in between tests where then he could infect his partner.  However I guess this is a risk they want to take. 

My friend has been positive since 1985 and basically a non-progressor.  I know there have been studies on non-progressors but I don't know about passing on the virus when being one.

Also, there seems to have been changes in the assumption when an HIV+ person chooses to have sex with a partner + or - he is then the responsible party.  But then I've heard the tables have turned and it is the responsibility of the receiver or partner.  In any case, in the straight or gay world, I assume if I was negative I would just take for granted who ever I am having sex with is positive until proven otherwise by a test or something.  So the risk is mine.

In this case, my friend's partner is consensual, but based on his kind of scary history, if he became infected I think there may be Hell to pay for my friend.  Kind of concerned about him and his judgment calls.

Any more thoughts please share.

And thanks again for your responses.  I will follow up on the links provided.

Best,

jm1953

[tednlou2]

Dr. Joel Gallant, a top HIV doc, just talked about this Swiss study on "John Hopkins HIV Guide".  You can find it on the web and even ask him questions.  Dr Gallant said he does believe it is virtually impossible to transmit HIV while undetectable.  However, he had the same concerns--how do you know you are undetectable on any given day.  You would have to have sex immediately following the viral load test--even then you can't be totally sure. 

As other's said, it depends on the kind of sex.  The CDC even says it is very unlikely to get HIV from performing oral sex--unless you have cuts in the mouth and the person has a very high viral load.  My partner is a total top and never got my virus from topping me or performing oral sex on me.  I was diagnosed one year ago, but have it for several years.  We take more precautions since finding out I was poz.  He probably was just lucky, but we do know that tops are at far less risk. 

So, I guess it depends on whether the person is willing to take the risk.  The World Health Organization just said HIV mothers should be on HIV meds so they can breast feed.  I thought that was irresponsible because how can those mothers always be sure they are undetectable.  I was bottle fed and turned out okay.   

[Inchlingblue]

  He probably was just lucky, but we do know that tops are at far less risk.  

Maybe so, but I do know a good friend who is a total top, he rarely if ever even performs oral sex, and he got it.

Part of what facilitates transmission of HIV is the presence of other STDs. Herpes especially has been linked with facilitating transmission of HIV and this happens even without the presence of an actual herpes sore. It can happen right before the sore has appeared or right after it has healed, the cells on that area of skin are more vulnerable. And not just herpes but gonorrhea, chlamydia, etc.

[Assurbanipal]

Maybe so, but I do know a good friend who is a total top, he rarely if ever even performs oral sex, and he got it.

Part of what facilitates transmission of HIV is the presence of other STDs. Herpes especially has been linked with facilitating transmission of HIV and this happens even without the presence of an actual herpes sore. It can happen right before the sore has appeared or right after it has healed, the cells on that area of skin are more vulnerable. And not just herpes but gonorrhea, chlamydia, etc.

Just to be clear, transmission estimates show all anal sex as far more risky than oral sex regardless of position.  While anal sex as the bottom is an order of magnitude or so riskier than as the top, an anal top still has far greater risk of HIV than any estimate of risk from oral sex -- no matter whose estimates you look at.

[Rjane]

Thanks for the information you guys!

I believe my friend was going on the assumption that if non-detectable for six months straight it is alright to have unprotected sex with your partner.  And as a side note, I forgot to mention he told me he is versatile in the sack meaning being the top or bottom.

One made a point one's viral load may go up and down in between tests where then he could infect his partner.  However I guess this is a risk they want to take. 

My friend has been positive since 1985 and basically a non-progressor.  I know there have been studies on non-progressors but I don't know about passing on the virus when being one.

Also, there seems to have been changes in the assumption when an HIV+ person chooses to have sex with a partner + or - he is then the responsible party.  But then I've heard the tables have turned and it is the responsibility of the receiver or partner.  In any case, in the straight or gay world, I assume if I was negative I would just take for granted who ever I am having sex with is positive until proven otherwise by a test or something.  So the risk is mine.

In this case, my friend's partner is consensual, but based on his kind of scary history, if he became infected I think there may be Hell to pay for my friend.  Kind of concerned about him and his judgment calls.

Any more thoughts please share.

And thanks again for your responses.  I will follow up on the links provided.

Best,

jm1953

I think str8 couples can. Not so sure about gay couples.

[ruralguy]

Gallant recently wrote in his Q&A that he doesn't believe there has ever been a documented case of transmission from an hiv+ person on meds.

[GSOgymrat]

Gallant recently wrote in his Q&A that he doesn't believe there has ever been a documented case of transmission from an hiv+ person on meds.

Not everyone who is on medication has an undetectable viral load. I wasn't undetectable until 2003 and it took a variety of combos to get there. I would love to believe that I can't transmit the virus but I won't believe it until I see more compelling studies.

[Miss Philicia]

Gallant recently wrote in his Q&A that he doesn't believe there has ever been a documented case of transmission from an hiv+ person on meds.

Either you or good ole Dr. Joel needs to more carefully phrase that.  I can assure you that I was infectious for 13 years on medication, as I still had a viral load for that long.

[jgallant]

Dr. G here.  I've been seriously misquoted!  I said I wasn't aware of a reported case of HIV transmission from someone with an undetectable viral loads.   That doesn't mean it's impossible, and it definitely doesn't mean that antiretroviral therapy prevents transmission.  There are plenty of people on treament who have high viral loads and who are capable of transmitting HIV (including resistant virus).

[edfu]

Dr. Gallant,

Thanks so very much for your gracious clarification.  It's extremely generous for you to take the time to respond to the misquotes on this board.  I know I speak for many when I state that we are more than grateful for your great work over the years.  Thanks again. 

[Tim Horn]

Gallant recently wrote in his Q&A that he doesn't believe there has ever been a documented case of transmission from an hiv+ person on meds.

Dr. G here.  I've been seriously misquoted!  I said I wasn't aware of a reported case of HIV transmission from someone with an undetectable viral loads.   That doesn't mean it's impossible, and it definitely doesn't mean that antiretroviral therapy prevents transmission.  There are plenty of people on treament who have high viral loads and who are capable of transmitting HIV (including resistant virus).

First off, to settle any doubt, yes -- that was the real Joel Gallant, MD, who stopped in to set the record straight.

Second, this is a great example of why we really, really like people to do their best to cite their references when quoting someone else or discussing information published elsewhere on the web. Not to single you out, ruralguy, but it would have been best if you provided a direct link to Dr. Gallant's authoritative discussion of this subject, to keep the information shared here as honest as possible.

Tim   

[ruralguy]

Here is a link to Gallant's archive in HIV prevention and transmission.

http://www.hopkins-hivguide.org/q_a/patient/hiv_transmission_and_prevention/index.html?siteId=7151&contentInstanceId=235736

I is certainly worht a read.  Unprotected sex is never ok.  No intent to miss lead anyone here on that point.

Going forward I'll simply provide the links without any comment.

[jm1953]

Dr. G here.  I've been seriously misquoted!  I said I wasn't aware of a reported case of HIV transmission from someone with an undetectable viral loads.   That doesn't mean it's impossible, and it definitely doesn't mean that antiretroviral therapy prevents transmission.  There are plenty of people on treament who have high viral loads and who are capable of transmitting HIV (including resistant virus).

Dr. Gallant:

I'm the member who originally posted this topic and wanted to say what an honor it is to see you on the forums.  I have admired your work and contributions for many years.

I'm sorry a member misquoted you.  As stated before the forum does ask members to cite their references when quoting someone else.  I'm sure he had the best of intentions. 

This topic has proven to be a controversial one, and there seem to be many points of view.  For me, this forum has been invaluable.  I hope we may hear more from you in the future.

Thank you again for your correcting us,

Respectfully,

Jeff

[sanitex]

 hi everyone
                    Is't possible to infect with another strain perhaps the person was undeiectable with the
virus maybe if someone was on another regimens not the same regimens with you is't possible to
have unprotect sex (virgina sex not anal sex)?

[tednlou2]

I'M CONFUSED NOW.  WASN'T THE MAIN QUESTION WHETHER YOU CAN PASS HIV IF UNDETECTABLE?  DR. GALLANT HAS MADE THESE STATEMENTS:  HE SAID, "...PEOPLE WITH UNDETECTABLE VIRAL LOADS DON'T TRANSMIT HIV."  I'VE SAID IN A PREVIOUS POST THAT HE DID QUALIFY THIS WITH THE POSSIBILITY OF NOT KNOWING WHAT YOUR VIRAL LOAD WAS ON ANY GIVEN DAY.  I'M JUST CONFUSED BY ALL THIS. 

OKAY, I'M A LITTLE SLOW SOMETIMES.  SOMEONE SUGGESTED DR. GALLANT DOESN'T BELIEVE ANYONE ON MEDS CAN TRANSMIT HIV.  THAT IS VERY DIFFERENT FROM WHAT HE HAS SAID ABOUT BEING UNDETECTABLE.  I WAS BLONDE AS A CHILD....KIDDING EVERYONE.   

chance of transmission

Joel E. Gallant, M.D., M.P.H.

Posted on Nov 25, 2009
--------------------------------------------------------------------------------
What is the chance of transmission from a positive woman with an undetectable viral load for 8 years to a negative man having unprotected sex a couple of times?

On Nov 25, 2009 Joel E. Gallant, M.D., M.P.H. replied:

--------------------------------------------------------------------------------
You'd be more likely to be killed by a tree falling through the roof of the house while having sex.

AND HE SAID THIS....

On Nov 12, 2009 Joel E. Gallant, M.D., M.P.H. replied:

--------------------------------------------------------------------------------
The "Swiss statement" was a statement based on data from multiple sources, not from a single "Swiss study." No one would ever make such a sweeping statement based on a single study--at least no one responsible.

As I've already said, I accept the basic premise of the statement: that people with undetectable viral loads don't transmit HIV. The primary concern has to do with the inability to always know whether your viral load is undetectable. You don't seem to be reading my answers very clearly, because I'm not disagreeing with the statment. I'm simplying saying that anyone considering practicing unprotected sex needs to consider the limitations before completely accepting the statement at face value. I have no problem with a couple trying to conceive naturally provided both parties are well informed, and the male partner has had a recent undetectable viral load.

[veritas]

Perhaps the conservative approach to this issue is the safest way to go. A good overview concerning passing on the virus can be found here:

http://www.aids.org/factsheets/125-viral-load-tests.html

"Some people may think that if their viral load is undetectable, they can't pass the HIV virus to another person. This is not true. There is no "safe" level of viral load. Although the risk is less, you can pass HIV to another person even if your viral load is undetectable"


If you have HIV, there is always the possibility to transmit without playing safe------period.

v

[Inchlingblue]

Additionally, as cited above, when it comes to transmission from a male (whether to a female or to another male) it has been found that even with those individuals that are undetectable in the plasma, detectable levels of virus were found in the semen.

LINK:

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


Of course if someone is undetectable the odds become such that the chances of transmission are very low, but I would not say it's impossible. And there's also the question of whether other STDs such as herpes are present, which make for a higher probability of transmission.

[Cerrid]

It's the same issue like kissing, and this has been solved in the mid 80ies: There's virus present in saliva, so it's not undetectable. However, the concentration is too low, so there hasn't been a single case where HIV has been transmitted by kissing. Hence it's assumed to be safe. Transmission is not impossible, but apparently very unlikely. Impossible isn't really a category in medicine, or life in general. You can never be 100% safe in life.

If all three criteria of the Swiss paper are met, transmission is highly improbable. Which means: It has never been observed in reality. If you're unsure about your own or your boyfriend's condition, better use condoms. If you're adherent, undetectable for at least six months in a row and you're both free of STI, then you both can play as you like. It requires some talks, but it's worth it.

http://www.aidsmap.com/en/news/4E9D555B-18FB-4D56-B912-2C28AFCCD36B.asp

[RapidRod]

Saliva has over a dozen different enzymes and proteins that inhibit HIV transmission.

[xman]

I guess he was referring to the statistical possibilities and did a comparison between transmission from saliva and from undetectable fluids like sperma and blood. Mathematically we approach a 0.0001% or 1 in 100.000 infection risk valid for both, which of course doesn't completely eliminate the possibility of infection but puts it at a negligible point. It would be the same risk as to be hit deadly by a truck.