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What is the likelyhood an HIV+ considered 'undetectable' can transmit?
Oct 22, 2003

A prison penpal I write with has asked me to look up some information for him and quite honestly I'm a little overwhelmed by the volume of HIV information on the Internet - I'm hoping you can help lead me to some credible basic websites with material I could print out and send to him. I would also appreciate your anwsers to a couple questions he has asked.

He recently (within a month)was the receptive partner with a guy who is HIV+ and has been on meds. He writes, "One night we decided to engage in anal sex using a finger from a latex glove as a rubber. They actually work very well most of the time. This time it didn't. It busted while we were having sex."

In his letter he self-chastised his behaviors and methodology. My own neck muscles got a workout shaking my head side to side as he told of the incident.

The two main concerns he has asked about are:

1. "Can a person, HIV+, on meds to the point where the virus is considered 'undetectable', still pass the HIV to the person he is penetrating?"

2. "How long after having sex with an infected HIV+ person does it take for the HIV to show up in your blood if you were infected?" He did not ask if he should get tested - he plans to - I believe he is asking when to test and know what his status will be.

Many thanks for your assistance with this.

Response from Dr. Frascino

Hi,

HIV information websites? Well, there are lots to choose from. Here are a few favorites:

1. www.thebody.com (of course!) 2. www.hivinsite.ucsf.edu 3. www.aegis.com 4. www.projectinform.org

Next, your specific questions:

1. Can an HIV+ person on meds with an undetectable viral load still transmit the virus? Yes, absolutely. This is often a point of confusion, even in HIVers. Certainly the risk of HIV transmission is greater with sky-high viral loads, but a significant risk still remains even with an undetectable status.

2. We recommend he wait 3 months for his first test, and since he had a very significant exposure (receptive anal sex), he should be retested at 6 months according to CDC guidelines.

I have spoken in several correctional facilities around California. HIV prevention and appropriate treatment remains challenging in these institutions. Have your pen pal spread the information around, if possible. Thank you for helping him.

Dr. Bob



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