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Transmission between serodiscordant males same sex couples
Apr 29, 2014

I have looked for studies that discuss the risk of HIV transmission between male partners, where one is on meds and has no viral load, and the other is negative. I found a 2009 study that documents transmission between a gay couple ( http://www.intmedpress.com/servefile.cfm?suid=8be42e39-7915-4b36-929c-0f1a603e989e ). This sited study references earlier studies that could not document transmission, even where the HIV positive partner had a viral load of 1500 copies per ml., but I think that the participants were having heterosexual intercourse. Can you tell me what the current scientific thinking is on the topic of serodiscordant transmission where the infected partner is on treatment and w/o detectable viral load, and if there is any statistically significant difference between similarly situated straight and gay couples . Thanks

Response from Ms. Southall

Hi There are ongoing studies. In the research conducted so far, there have been no recorded HIV transmissions among heterosexual couples where the HIV-positive partner is on treatment and their blood viral load is undetectable. However, this does not mean the risk through condomless sex is zero. All of the couples studied to date have also reported using condoms often. This makes it difficult to determine the risk of HIV transmission when no condom is used.

Although there have been no studies among gay men and other MSM, there has been one report of HIV transmission occurring between two men when the HIV-positive partner had an undetectable viral load.

Also, the risk of HIV transmission when the viral load is undetectable may not be the same for all types of sex. This risk may be higher for anal sex than for vaginal sex, particularly if the HIV-negative partner is the receptive partner (bottom) during anal sex. This is because receptive anal sex generally carries a higher baseline HIV risk than other types of sex.

There are ongoing studies following serodiscordant heterosexual and same-sex couples who are taking HIV treatment, have an undetectable viral load, and do not always use condoms. These studies will provide a better understanding of the risk of HIV transmission when the viral load is undetectable.

The risk of transmission with an undetectable viral load is incredibly low. There are some providers that are comfortable saying no risk at all and others who say yes the risk is incredibly low but don't feel comfortable yet stating that there is no risk.

It is definitely something to keep your eye on and keep abreast of the research as studies do continue. But the overall view is great news and an incredibly low risk of transmission with an undetectable viral load.

Be well and stay safe, Shannon



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