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Transmission where viral load is undetectable (REALLY A NEW QUESTION, I PROMISE!)
Feb 2, 2008

Hi Dr. Bob,

Have you seen the story, reported today, that Swiss researchers are saying that HIV "cannot" be transmitted from an HIV-positive sex partner to an HIV-negative sex partner -- at least when they are in a stable relationship? There are a few caveats, of course, but on its face it sounds like a pretty bold and nearly absolute statement.

Here is a link to the story:

http://aidsmap.com/en/news/4E9D555B-18FB-4D56-B912-2C28AFCCD36B.asp

I would love to hear your opinion!

Response from Dr. Frascino

Hello,

Oh yes, I've seen it. In fact, the phone has been ringing off the hook since it hit the broader media markets. The statement in the Bulletin Des Médecins Suisses was made by the Swiss AIDS Commission after careful review of four studies that focused heavily on heterosexual couples and vaginal sex. The report suggested HIV-positive folks on potent and effective antiretroviral drugs who are adhering to their treatment regimen and who have suppressed their HIV plasma viral load to an undetectable level for at least six months and who do not have other concurrent sexually transmitted infections, are not sexually infectious, i.e., they cannot transmit HIV through sexual contact. This really is not such astounding news. We have been saying for quite some time that suppressing the HIV plasma viral load reduces the risk of HIV transmission significantly. To say that it completely eliminates this risk is still premature in my opinion. The current report did not provide information about anal sex. Also how does one know with certainty that his HIV plasma viral load is suppressed to an undetectable level at the time he/she wants to have commando fusion sex with a horned-up hottie? Viral loads can very quickly rise for a variety of reasons, including non-adherence to anti-HIV therapy, concurrent illness, vaccinations, emergence of drug resistance, etc. Are these risks an HIV-neggie is willing to take to avoid using a condom? In other words it will be very difficult to "certify" that your sex partner actually meets all the criteria listed by the Swiss report.

Certainly this report will generate much discussion as to its implications for doctors, magnetic couples, HIV-positoids, HIV-prevention efforts, the legal system, etc. I welcome the discussion, but I'm not looking forward to the flood of questions related to this story that are this very moment cramming their way into my inbox.

Dr. Bob



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