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How much less risk if viral load is undetectable?
Apr 17, 2000

Dear Dr. Holodniy,

In your answer to a recent question on viral load and transmission you say that there appears to be much less risk of transmission when people have an undetectable plasma viral load. Can this "much less risk" be expressed in figures? Are there any data available that suggest how much less likely it is to become infected by having unprotected sex with someone who is HIV positive and has an undetectable viral load (<80) compared to having it with someone who has a high viral load?

Are there any data available that in general could tell how chances are to get infected by having unprotected sex with someone who is HIV positive and has an undetectable viral load, like e.g. chances are 1 to 30 or something like this?

Thank you for your answer.

Response from Dr. Holodniy

A recent study from Uganda published in the New England Journal of Medicine 2 weeks ago, found that in a couple hundred discordant couples (one HIV positive, one negative), there was no transmission when the viral load was < 1,500. I don't think I would say at this point that the risk is negative below that viral load. More data needs to be collected. I still also would not give odds.

MH



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