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Undetectable sex risk

Jul 5, 2013

Hi. My girlfriend and I are both on atripla. We are both undetectable, and both have excellent CD4 counts. How safe is condomless sex given we are both faithful to each other? Oral sex? Thanks!

Response from Dr. Wohl

This is a good question that we get regularly. The risk of transmitting HIV goes down markedly when the viral load is suppressed by treatment. So, while no one can guarantee that infection from someone with an undetectable viral load is impossible, it seems to be very improbable.

In your case, the risk is not infection but spreading a drug-resistant strain of HIV. This would take one of you missing meds and then developing a resistant virus and then being able to transmit that virus to your partner. Again, unlikely provided you stay faithful to your meds and each other (so as not to introduce other STDs).

You a re both grown-ups and can make a grown-up decision whether the very low risk of transmission of a resistant strain obligates you to use condoms or not.


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