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hiv transmitting
May 21, 2013

undetectable with below 20 copies and cd4 400, no sti should i be worried about transmitting HIV to my negative partner

Response from Dr. Wohl

This is an important question. Until recently the answer would be we do not know. However, results of a study done mostly in the developing world and involving heterosexual discordant (HIV+ and HIV-) couples showed that treating the HIV+ with HIV meds reduced transmission of HIV almost completely.

The question now is can we extrapolate from these data? This was a study and there was great care taken to keep the HIV+ folks on their meds. STIs were sought and treated. And, this involved heterosexual sex. We do not know if the same results would arise from a study of men who have sex with men.

My suspicion is that reducing the virus in the blood to very low levels protects against transmission with any type of sex. Studies are going forward to confirm this.

Meanwhile, I would take the data that are available and along with your partner make decisions that are right for you. Obviously, condoms provide greatest assurance of protection to your partner (and to you if your partner has an STI). If in a monogamous relationship (thus keeping STIs out of the picture) and adherent to your meds you could discuss not using condoms, if you both agree. Your partner could also consider taking pre-exposure prophylaxis (PrEP) but most (including me) would consider this like wearing a belt plus suspenders.

The good news is that you now have options.

DW



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