Please Note: Due to volume considerations, not all questions can be answered. Questions most likely to be answered will be those of general interest to a broad group of visitors to this forum. Questions pertaining to a specific case; requests for diagnosis, medical advice, or second opinion; or requests for opinions about untested alternative therapies will generally not be answered.
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Undetectable but concerned
Nov 27, 2002
Hello. I have been HIV+ for one year and have been on meds for 6 months. I am now at an undetectable viral load. Does this mean that I my semen is HIV free? Can I have safe sex with HIV negative men and not worry about infecting them even if the condom breaks?
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Response from Dr. Remien
No, it does not mean that your semen is "HIV free.;' nor does it mean that your plasma (blood) is free of virus. It means that the level of viral replication, at the time your blood sample was taken, was at a level below the sensitivity of the assay (test) that was used to measure your viral load. And it is a good thing to have a very low viral load. However, even at such a level, the virus is always reproducing in your body and will fluctuate depending on many factors (e.g., time of day, other viruses or bacterial infections, etc.). Also, while there is generally a relationship between the viral load in plasma and the viral load in genital secretions (e.g., semen), it is not a 1:1 correspondence. That is the viral load in your semen could be higher at a given point in time than it is in your blood.
This is why the recommendation for continued "protected sex" remains even when a person's viral load is seemingly fairly well controlled. Consistent and correct use of condoms is an excellent prevention strategy. If there is a condom break and especially with ejaculation, an HIV- sex partner may want to consult with a doctor very quickly after the event and consider receiving "post-exposure" treatment.
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