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Does Length of Time with hiv affect transmission?
Dec 13, 1999

Hi. I have heard that people who have had hiv for a number of years have developed their own mutated strain of the virus making it less transmittable (sp?) .... is this true?? and does being on the cocktails (anti-viral) with a zero viral load make it harder to transmit the virus... do the drugs hinder the virus as goes transmission?? I appreciate your time.

Response from Dr. Remien

Although I am not a physician I will respond to your question because it is one that comes up often for couples of mixed HIV status. It is true that HIV, in its normal course of replication, always has the chance for mutating to some degree. Which simply means that the virus can look a little different, over time, within a given individual. However, the change does not make the virus either more or less infectious. The virus, when present, can always be transmitted to another person.

When someone is on antiretroviral therapy the virus is more likely to mutate in ways that make it less susceptible to the medication that person is taking. That is why "adherence" to treatment is so important once someone decides to start taking combination antiretroviral therapy. If there is insufficient suppression of the virus (as happens when people miss doses of medication), the virus has a greater likelihood of mutating. The danger in this type of mutation is that the treatment will become less effective with time, leaving the person more vulnerable to becoming ill. Also, if that "resistant" virus is transmitted to a sex partner, that person will now be infected with a virus that is already resistant to some medications, meaning treatment will be less effective for that person who is newly infected.

There is some evidence that less virus means lower infectiousness. So that there "may" be a lower probability of transmission with each risk act. However, an undetectable viral load of plasma (blood) does not always correspond with the viral load of genital secretions. In other words, you can have a low viral load in your plasma, but have a higher viral load in other parts of the body (e.g. lymph nodes and genital secretions). And an "undetectable" viral load does NOT mean "zero" viral load. It just means that it not detectable by the currently available assay (test). We know that when an HIV+ person has an undetectable plasma viral load (the test you get from your doctor) there is still sufficient virus, especially in genital secretions, for the virus to be transmitted to a partner.

Bottom line: As much as couples would like to do away with condoms and engage in riskier behaviors when the HIV+ person in on successful therapy, unfortunately this absolutely cannot be recommended. Safer sex precautions are still required.

Again, remember that I am not a physician, and you should ask your question directly to a doctor or medical expert. However, my response to you is an informed one and will not differ significantly from that of a medical expert.

mixed serostatus couples in Sacramento area.
I stress out my HIV+ partner

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