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HIV positive but uninfectious?
Dec 29, 2008

Dr. Bob, Belated congratulations on your marriage and please accept my sincere best wishes for your every happiness. Thank you also for Obama. this is something I say to every American I speak to for the first time. I feel I should welcome you all back to the planet. You are all cool again. I know you have been asked many times and resisted the temptation to say when a cure will be found. I do not imagine you are about to stick your neck out about that issue now. However, I wonder whether you would be prepared to say when HIV positive people will be told with a responsible degree of certainty by their doctors that they are not infectious? When are we going to know enough about the relationship, for example, of viremia to virus in seminal or vaginal fluid? When are we going to be prescribed antiretrovirals that are more able to penetrate the sex organs? When is it that as part of considerations for what drugs to prescribe doctors advise on the degree of infectivity that can be reduced? I suspect giving answers to these questions would not involve a complete leap in the dark. Many thanks. God bless you.

Response from Dr. Frascino

Hi,

Unfortunately not even I have an infallible crystal ball that can predict the future.

As for the relationship of viremia to virus in the seminal or cervical secretions, we actually have accumulated quite a bit of data. The results show it's somewhat variable from person to person, but in general there is a fairly good correlation with the newer more potent antiretroviral drug regimens. What I can predict is that we won't be able to advise HIVers that they are absolutely noninfectious anytime soon. Even if antiretrovirals drive HIV plasma viral loads to undetectable levels based on periodic blood tests, there is still the problem of occasional "blips," nonadherence to medication regimens and the development of drug resistance. All these factors could affect infectiousness. So for now, and the "foreseeable future," safer sexual techniques are the name of the game.

Happy Holidays.

Dr. Bob



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