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Risk of infection from long-term non-progressor
Feb 21, 2001

I am a gay man involved in a monogamous relationship with a long-term non-progressor. My boyfriend is participating in a clinical trial at N.I.H., so we know that he has had a viral load of zero for several years. When he receives his check-ups at N.I.H., he generally has his blood tested, though he has also had his semen and his spinal fluid tested in the past. He has never shown any viral load whatsoever.

I am wondering about the significance of his zero viral load, insofar as our sexual practices are concerned. Honestly, I have to say that I have already started making sexual decisions based on his zero viral load. For example, when we have oral sex I sometimes suck him until he ejaculates in my mouth. My assumption is that his zero viral load means that there is little, if any, risk of HIV transmission from my boyfriend.

Am I reading this correctly? Or am I wrong? By the way, I do appreciate the fact that his viral load may change without notice.

Thanks for the answer.

Response from Mr. Kull

You ask an important and difficult question.

First of all, when you say your partner's viral load is "zero," do you mean "undetectable"? An undetectable viral load does not necessarily mean that there is no virus in plasma, it just means that the particular test did not detect any virus below a certain amount (which is usually very low). An undetectable viral load is a great sign--some studies have shown that individuals with undetectable viral loads are less likely to infect their sexual partners than someone with higher viral loads--but be careful of misinterpreting the terminology.

As in your boyfriend's situation, the viral load tests generally performed look for virus in blood and not in other bodily fluids. It is believed that HIV can be compartmentalized in certain regions of the body. This is important because some studies show that an undetectable viral load in a person's blood does not always mean that there is a corresponding undetectable viral load in semen (or cervical-vaginal secretions). Again, it is a good sign that he did not have detectable virus in his semen, but that doesn't mean "no virus" and it sounds like his semen is not generally monitored.

Only you can decide if you are going to get your partner's semen inside of your body. While giving oral sex is lower risk than anal sex without condoms, the more you let your boyfriend ejaculate in your mouth, the greater the odds that you will come into contact with HIV. There is no way to predict if you will be infected, so I would tend to say play it on the safe side.

I understand that "taking in" your partner's semen might be highly important and desirable for you, but the risk for infection could be there. Many mixed-HIV-status couples face the kind of dilemma that you face. It is difficult to live with the barriers that HIV places in front of you, and it makes sense that you would want to believe that your boyfriend can't infect you. It's a tough choice.

RMK



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