|Does HIV/HCV Viral Load Affect Likelihood of Transmission to Others?
Jan 19, 2001
I'm a 29yo severe hemophiliac co-infected with HIV & HCV since the early 80's. I was also HBV infected, but cleared the disease on my own years ago. I've been on Epivir & Zerit since 8-96 and a protease inhibitor (currently Viracept) since 10-96. My HIV vl was undetectable even after only the first 6 weeks of d4t & 3tc and has remained that way ever since. My T-4 count has fluctuated between 350-600 since before anti-viral therapy. My HCV vl is 825,000 and my liver enzymes are currently fluctuating between normal and slightly elevated and have never been more than about 1.5 times normal. I've never had a biopsy, since the hemophilia complicates the procedure. For years I thought I had been robbed of the ability to safely have a family. My outlook on this has greatly improved and I got married in 9-99. Finally my question... Does my viral load of either HIV or HCV (or both) have any impact on the likelihood of transmission to a sexual partner. My wife is fully informed, but she is reluctant to use condoms, partially because we want to have natural children. I read early last year about studies done in Africa that seemed to show that the likelihood of transmission for patients with undetectable HIV viral load was very low. In fact, I seem to remember that none of the undetectable patients' partners seroconverted. I realize that studies done in Africa may not be up to the standards of research done in the U.S., but I'm sure you understand how someone in my shoes might be cautiously excited by this news. Are you familiar with the study I'm referring to and do you know of any follow-up studies on the subject? Has any similar study been done relating to HCV? The concept does seem to make sense in theory, at least. I'm interested in your thoughts on this subject and look forward to your response. BTW, sorry my post was so long. Thanks.
Response from Dr. Dieterich
The likelihood of transmission of HIV is probably related to the viral load in your blood. However, there is a small chance that there may be HIV in the semen regardless of no viral load in the blood. There are people who are washing semen now to try and inseminate serodiscordant couples. So while the risk is low there is always some risk.
Sexual transmission of HCV is very rare, although more common in the presence of HIV. Heterosexual vaginal intercourse represents a low risk of transmission of HCV as long as there is blood involved. By the way you don't need a liver biopsy to get treated for HCV. You are doing so well now with HIV consider the pegylated interferon and ribavirin this year and you can possibly cure the HCV and not have to worry about it! Good luck! DTD
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