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Non-detectable does not equal Non-Infectious
Aug 27, 2001

Could you explain how being non-detectable would lessen being infectious? Also, is there a way to determine how much of a viral load there is in semen?

Response from Dr. Pavia

This is an important issue. Treatment does not make people non infectious, even if their viral load is undetectable. It does, however, reduce the risk of transmission per exposure.

Why? Well, there is a relationship between the amount of virus in the semen, or in the cervical secretions for women, and the amount of virus in the blood. ON AVERAGE, the amount of virus in seminal plasma (essentially the liquid part of semen) drops as the plasma viral load drops, BUT NOT ALWAYS. Also, there are often white blood cells in semen and in vaginal secretions, and these cells can harbour virus.

Testing the amount of virus in semen would be misleading. If there were no detectable virus today, there may be virus tommorrow, or after something causes inflammation. This could be as simple as an infection (like gonnorhea) or injury from vigourous or traumatic sex.

Bottom line (no pun intended) is that it is better to have a lower viral load, but it does not make you or your partner non infectious. Safer sex is still necessary. It is more dangerous to juggle 10 hand grenades than 2 hand grenades, but it only takes one to blow you away.


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