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HIV not detectable in HIV+ Person?

Apr 15, 2006

Hello Doctor

I have recently met this guy who is visiting my country, and we clicked. He is in his mid-forties and he looked always a bit "pale" in the face but I didn't think a big deal about it. Nothing sexually has happened between us (yet), only a few kisses and cuddling. Now, here's what happened next..

He told me he was infected with HIV 15 years ago. He followed treatment and while if he makes a test he will be still HIV+, he is not contaminating: in other words; and in his words: "there's no risk and he cannot infect his boyfriend" due to "the miracles that modern treatment can do". In other words: there is no VIRUS in his system!!! This happened just yesterday .. he said he could've made love to me without feeling it dengerous on me to get infected, but he wants to be "honest" with me so I wouldn't freak out later. The thing is, he likes me (and I think he is falling in love) and I am feeling the same.

My main inquiry here: IS THERE A CASE IN REALITY WHERE AN HIV+ MAN CAN BE SAFE FOR HIS BOYFRIEND? even assuming that we will always use protection?

Thanks a lot

Response from Dr. Frascino


Your new boyfriend is unfortunately either very ill-informed or in a state of dangerous denial.

First, the facts:

1. He is HIV+.

2. All HIV+ folks are infectious (capable of passing the virus on to their partner), even if their viral loads are "nondetectable" or "undetectable."

3. Having a nondetectable HIV plasma viral load does not mean there is no virus in the blood. It just means that there is not enough for the test to count ("to detect"). With our first viral load tests, "undetectable" meant up to 9,999 copies! In other words, "undetectable" depends on the sensitivity of the test used.

4. Your friend may think that if his viral load is undetectable, he cannot transmit the HIV virus to another partner. This is not true. There is no "safe" level of viral load, including "undetectable." It is true the degree of risk of transmission is less when the viral load is suppressed; however, it is essential to realize that an HIV+ person can pass HIV to another person, even if the viral load is undetectable. It's worth noting that only about 2% of the total HIV virus in an HIV-positive person's body is in the blood. Viral load tests do not measure how much HIV is in body tissues, like lymph nodes, spleen or brain or body fluids, like semen.

I'm glad you asked your question before placing yourself at risk. I suggest you show this post and my response to your new boyfriend. He, in turn, should discuss it with his HIV/AIDS specialist. If he wants to be "honest," he needs to understand the basic realities of his HIV-positive status, particularly the undeniable fact that he is infectious and must use safer sexual techniques (latex condoms) to prevent infecting his sexual partners.

Stay safe.

Dr. Bob

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