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I am undetectable
Oct 17, 2008

My viral load is undetectable, my boyfriend and I have anal sex, but I am the anal recepiant. So he he is negative, I am positive. He is on 'top', unprotected, what are the stats for him possibly getting HIV ?

Response from Dr. Frascino

Hi,

This is a QTND (question that never dies). See below. The estimated per-act risk for acquiring HIV via unprotected insertive anal intercourse with a partner confirmed to be HIV positive is 6.5 per 10,000 exposures. That your viral load is undetectable significantly decreases the risk of HIV transmission, but it does not eliminate it. I would strongly encourage the use of condoms. You might also consider other harm-reduction strategies, such as enrolling in one of the PrEP (pre-exposure prophylaxis) clinical trials for magnetic couples. You can read more about PrEP in the archives.

Good luck to you both.

Dr. Bob

Dr. Bob, I need some help (SWISS AIDS COMMISSION REPORT) (MAGNETIC COUPLE RISK, 2008) Oct 16, 2008

Dr. Bob, I've been reading your forum for years but never asked a question. This time I need your advice. My name is Alex and been HIV+ for 6 years. My viral load is undetectable and CD4 1,050. I am starting a very promising relationship with an adorable man. He is HIV-. The issue has not been a problem for us, but we had "unprotected" sex a few times I was the receptive. There was not ejaculation. Intercourse for a few minutes. I know none a doctor would advice to continue with this practice. We concluded that it is not an extremely risky behaviour since he is not the receptive and my viral load has been undetectable for years. We discused this with a doctor and we got an ambiguos response. We understand that doctors can not encourage this practice. What do you think? Thank you so much.

Response from Dr. Frascino

Hello,

This is a complex subject. The discussions about this topic at the recent International AIDS Conference in Mexico City centered on the Swiss AIDS Commission Report that was released in February 2008, which suggested HIV-positive folks receiving effective antiretroviral therapy do not pose a significant risk of transmitting HIV to their negative partners during unprotected sex. The Swiss Commission reviewed data from four studies involving heterosexual couples. One study involving 393 magnetic couples concluded that when the HIV-positive person in the couple adhered to his medication regimen, had an undetectable HIV plasma viral load for at least six months and did not have any concurrent STDs, there was no HIV transmission to the negative partner during unprotected vaginal intercourse. However, another study found 6 out of 43 HIV-negative partners did become infected with HIV as a result of unprotected sex. Apparently, in this study the HIV-positive partners were not completely adherent to their antiretroviral treatment regimen.

It's important to note the Swiss report did not recommend that HIVers on effective HAART forego using condoms or other safer sexual practices. However, many AIDS prevention organizations worldwide have expressed enormous concern that the commission statement might result in reduction of condom uses among HIV positives on HAART. It's important to note the studies did not evaluate anal sex or men having sex with men. Consequently, I wonder on what basis you "concluded that it (unprotected anal sex) is not an extremely risky behavior." I do agree with some of your reasoning regarding risk reduction. For instance, there is considerable scientific evidence to support the conclusion that for magnetic couples any type of penetrative sex is less risky for the insertive partner compared to the receptive partner. It has also been well documented that driving the HIV plasma viral load down to undetectable levels significantly decreases the risk of HIV transmission. However, these facts do not eliminate the risk of HIV transmission. Similarly, other harm-reduction strategies, such as pulling out before ejaculation, reduce, but do not eliminate, transmission risk. Some magnetic couples have begun using PrEP (pre-exposure prophylaxis), antiretrovirals taken prophylactically by the negative partner to (hopefully) prevent HIV acquisition. Clinical trials are underway to evaluate the efficacy and safety of this intervention.

Only you and your partner can decide what level of risk is acceptable to you both, based on what is known scientifically and what each of your comfort levels are with your various sexual rituals.

You asked what I think. As you may or may not know, I have been in a magnetic relationship with Steve (Dr. Steve, the expert in The Body's Tratamientos forum) for 15 years. I'm "virally enhanced" and Steve is negative. Evaluating what is known scientifically, I, personally, would not be comfortable having unprotected sex with my partner, even though my HIV plasma viral load is undetectable. I never could or would put him at risk for HIV. No way. No how!

Dr. Bob



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