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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?

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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