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hiv positive hemophiliac
May 8, 2002

My boyfriend is an hiv positive hemophiliac. He contracted the virus during the early 80's as did a large perecentage of the hemophiliac population. He has been living with the virus for over twenty years and is no longer taking any meds. His viral load is incredibly low - practically non - existant from what i understand. Does this mean that he is likely to live a "normal" life and never develop any symptoms? Are my chances of contracting the disease lower b/c of the manner in which he contracted the disease, the fact that he is a hemophiliac, and the fact that his viral load is so low? Thank you for taking the time to help me better understand my situation.

Response from Dr. Remien

You are asking very good questions, but ones that are difficult to answer with precision or certainty. There have always been people infected with HIV who have lived long-term without any progression of their illness or significant impairment to their immune system, even without the benefit of medications. They are called "long-term non-progressors." It is believed that there are different reasons why some people fall into this group, and that these long-term non-progressors often differ from each other. For some, it seems to be that the virus they were infected with was a weakened strain of virus ("attenuated" virus). For others, it seems their immune system has been able to fight off the devastating effects of HIV and be "protective." For some it is a combination of these two factors and/or other factors, not clearly specified.

Now, of course, many more people are living as long-term non-progressors thanks to the benefits of effective antiretroviral therapies. While HIV is still a serious disease, and people do still get sick and die from its complications, many more people can be expected to live long-term with HIV, without serious complications from the disease.

Regarding chances of HIV transmission - mode of infection has nothing to do with level of risk of transmission to others. However, viral load, as well as the status of the host's immune system (and their general health) appear to be factors in the likelihood of transmission, as does the general health of the person to whom the virus might be transmitted. The basic principles are that the more virus there is, the easier it is for the virus to be transmitted, and the poorer the health of the people involved (e.g., weakened immune systems, abrasions in mucous membranes or co-infections, etc.) the easier it is for the virus to be transmitted. HOWEVER, these are factors that are shown to be correlated with HIV transmission in studies of groups of people. Individuals, or couples, cannot make decisions about risk based solely on these types of factors. HIV transmission is always possible when someone is infected with HIV, no matter how good their health or how low the viral load. Transmission of HIV does happen even when viral load is undetectable and both people are in excellent health.

Thus, there remains uncertainty in all of the above issues. While people are living longer and healthier with HIV and there is good reason for hope and optimism, HIV is still a serious disease, with negative outcomes for some. And while transmission of HIV may be "less likely" under certain circumstances, transmission to uninfected individuals still can occur when risks are taken. As a mixed status couple you need to consider all of these things, communicate your feelings and concerns with each other, and make your choices accordingly. Think of all the ways you can protect the health of both of you, and work together to keep each other healthy and safe, while not being afraid to love and live your lives with pleasure and satisfaction.

How big is the risk?

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