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Undetectable - How infectious am I?
Aug 8, 2001

Hey Ryan!

I am a male and have been on HAART for nearly 3 years with an HIV RNA below 50 copies. Recently Ive begun dating a girl who is HIV-. Im curious; how contagious am I with an undetectable viral load? How risky is it for her when she performs oral sex on me? What about unprotected intercourse without ejaculation? With all that said, am I putting her at any risk whatsoever by going down on her? I really love this girl and want to protect her from all evil. Doesn't the fact that I'm undetectable mean that I'm much less contagious than if I were runnung a massive viral load? Any advice will be taken to HAART! Thanks for youre awesome website!

Response from Mr. Kull

You ask a lot of important questions, many of which do not have exact answers and are scientifically complicated. On a very basic level, it is important to recognize that it IS possible that you could transmit HIV to your partner when her mucous membranes or bloodstream come into contact with your fluids (primarily blood and semen). So it's important to be aware of that when making sexual decisions with her.

Many recent studies support the idea that concentrations of HIV in blood are correlated with likelihood of sexual transmission; more specifically, the lower the viral load in blood, the less likely HIV will be transmitted sexually. One study of serodiscordant couples in Uganda found that sexual transmission did not occur when the infected partner's viral load was below 1500 copies/mL. Other studies demonstrated that as viral load increased, transmission did occur, but lower viral load in blood did mean lower odds for transmission. More studies need to be conducted, but the initial findings strongly support the use of antiretroviral therapy as a preventive tool.

While the levels of HIV in blood are likely to be correlated with levels of HIV found in semen or vaginal secretions, genital secretions may contain infectious levels of HIV when HIV concetration in blood remain low. Some medications may not be as effective as others in reducing the levels of virus in the genital tract. Other factors, like the presence of genital STDs, may increase the amount of virus present during sexual contact or the risk for infection. Again, more research in the future should be helpful in this arena.

Unprotected vaginal or anal sex without condoms, with or without ejaculation, is not recommended. Your girlfriend performing oral sex on you does put her at some risk for infection, but the risk for transmission is lower than vaginal or anal sex. There is virtually no risk to your girlfriend when you perform oral sex on her. For more about oral sex, see "What you should know about oral sex" (http://www.thebody.com/cdc/oralsex.html).

RMK



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