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Undectable Viral Load and Unprotected Sex
Nov 17, 2003

I tested postive in 1987. I have always been asymptomatic and healthy. I currently take Combivir and Viramune. My viral load has always been undetectable. CD4 always 500-680. Before testing positive my lover and I at the time had unprotected sex for two years. He continued to test negative for a year afterwards. My question - have any studies been done regarding virus transmission from positive persons with undetectable viral loads? Are the risks lower for unprotected anal intercourse with pulling out before ejaculation? Signed ~ Kansas Prairie Man

Response from Dr. Frascino

Hello Kansas Prairie Man,

Sixteen years, non-detectable viral load, and CD4's 500-680? Excellent! An inspiration for us all.

Here's what we know about HIV transmission. Receptive unprotected anal sex with an HIV-positive partner has the highest probability of HIV transmission per episode (estimated to be 0.1 3 percent). That said, studies have suggested the degree of risk is decreased if the viral load is undetectable. However, there are some studies that have shown the viral load in the ejaculate may not be the same as the viral load in the blood. Also, not ejaculating also decreases the risk to some degree. However, the key point here is that we are talking about levels of risk. Anal sex is risky, no matter what you do. The good news is that your lover has tested negative, despite some degree of exposure and risk. Bottom line -- protect him and his negative status by always using latex condoms, and consider PEP if there is a condom failure and significant exposure.

Stay well!

Dr. Bob



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