HIV Transmission from HSV

[findingaway]

I have been living with HIV for a bit now and recently found out I have genital herpes. I have done a lot of reading on the subject, but a ton seems to be 10 years old and doesn't really address someone that is undetectable. My concern is I met a great guy and he is aware of my status, however I am concerned on whether I could transmit HIV to him through my skin by me having HSV? He does not have either virus (and I want to keep it that way). I know condom is the way to go all the time, however, HSV can still be spread from skin that is not covered by the condom, hence lies my concern. I am more the receiver in the relationship, in case that needs to be stated. I have been undetectable for quite a while now and I chose to be on suppressive therapy for the HSV. I tried to talk to my NP about this, however she was not too informed. A little help would be great

[Jim Allen]

First things first, congratulations on finding a great guy and wishing you both all the best. 

Stop reading things from 10 years ago and keep in mind herpes, its one of the most common STI in the world.

So lets take this back a step and work forward, to start with Herpes does not change how HIV is transmitted, if it did the planet would be fucked no joke. 

Herpes is very different than HIV and can be spread even when its not visible through a process called viral shredding, and is spread outside the human body through skin on skin contact. Thankfully HIV is very different in that aspect and no amount of Herpes is going to give HIV wings or change how HIV is transmitted.

The theory of STI "increasing" the odds of HIV transmission is if the HIV negative person has a preexisting STI causing lets say as example inflammation or open sores within their anal or vaginal track or top of the penis than it might when they take an already known risk, lets say unprotected intercourse increase the likelihood of HIV being transmitted via the open wounds inside the confides of the human body.

However that changes when you are UD and, in real world studies far more recent ones like the partner studies as example even with preexisting STI it still that yielded no HIV transmissions ! Now the calculated odds in theory are sightly higher but that theory as its not happened. https://www.poz.com/article/undetectable-meant-zero-hiv-transmissions-87000-condomless-sex-acts 

One explanation for this is perhaps by going back to biological basics for HIV to transmit even in theory regardless of herpes, HIV must be present in an infectious body fluid from the HIV positive person, it must be present at sufficient levels to cause infection. There must be an effective route of transmission, and it must reach susceptible cells in another person.

So suppressed viral load, nothing to transmit to begin with and going back for the last 20 years we know that blood levels of viral load do correlate to genital levels albeit some delay perhaps and hence the UD statement takes this into account by saying you should be UD for at least 6 months before U=U. Also as explained no amount of Herpes is going to change the conditions needed for HIV to transmit in any situation regardless of UD status

Sorry to hear your doctor could not be more clear on this.

Hope this somewhat helps

Jim

[Jim Allen]

Oh and I moved your thread here as its bout prevention, its mainly open to more seasoned forum members and the mod team who can assist you.

Another way of looking at it is out of studies people with an STI the VL showed little to no change and, to be honest its rather irreverent because if you had a detectable VL for whatever the reason being including the STI you would know about it on your VL tests that are showing UD.

Jim

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4486691/

[findingaway]

Jim,
Seriously thank you man. You are the shit. It was super annoying reading the old articles from ten years ago and yeah my NP was not good with explaining much. I just got super paranoid and would never wanna hurt anyone. And since I contracted HSV while using a condom, it made me super uneasy. I like being informed and all that. Much appreciated!

[Jim Allen]

You're welcome

And, worth mentioning again congrats on finding finding a great guy, enjoy it 

[Jim Allen]

Hiya

Next to what I already stated and history from past studies showing HIV suppression with ART even with STI's, today I was reading this one today that supports the evidence already known and was thinking about your thread.

https://onlinelibrary.wiley.com/doi/10.1002/jia2.25186

Sexually transmitted infections and HIV RNA levels in blood and anogenital compartments among Thai men who have sex with men before and after antiretroviral therapy: implication for Treatment as Prevention programme

In (plain) English:

Full write-up:
http://www.aidsmap.com/Study-confirms-STIs-make-no-difference-to-undetectability-and-infectiousness-in-people-taking-HIV-treatment/page/3345560/

Study confirms STIs make no difference to undetectability and infectiousness in people taking HIV treatment

A study conducted with gay men in Thailand has found that people who are diagnosed with HIV and start antiretroviral therapy (ART) are no less likely than others to have an undetectable viral load if they are diagnosed with a sexually transmitted infection (STI).

This confirms the generalisability of the “Undetectable = Untransmittable” (U=U) message. It shows that the original Swiss Statement on undetectability and transmission, issued ten years ago, was too cautious when it excluded people with STIs. ...

[Hope4life]

Thanks Jim I read this thread to get more clarification on the concern and this answered every bit of it. I got one more article related to the same thought to share that with you..
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4486691/

which proved that the average effect of STI co-infection on HIV viral load in individuals on ART is less than 1 log10 difference, and thus unlikely to decrease the effectiveness of treatment as prevention.

thanks indeed