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Massive Change in U.S. Treatment Guidelines

January 2010

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Reducing the Risk of HIV Transmission

The panel is aware of research from high-income countries that suggests an increase in unprotected sex that began after the introduction of potent anti-HIV therapy. Indeed, in some studies, rates of unprotected intercourse have doubled since that time.

An analysis of several risk-behaviour studies -- a meta-analysis -- has found that people who believed that taking anti-HIV treatment or having an undetectable viral load in the blood prevented HIV transmission were more likely to engage in unprotected intercourse.

Data from observational studies suggest that anti-HIV therapy may reduce the risk of HIV transmission among heterosexual couples. Observational or cohort studies are good at finding associations but they cannot prove that taking anti-HIV medicines will prevent the transmission of HIV.

In 2008, a trio of Swiss researchers issued an opinion stating that HIV-positive people were sexually non-infectious under the following conditions:

  • they were taking anti-HIV therapy and their viral load was consistently undetectable; that is, less than 40 or 50 copies, depending on the assay used
  • there was complete adherence to therapy
  • they were in a stable relationship
  • they had no sexually transmitted infections (STIs)

Although under these conditions viral load in the genital fluids may sometimes be reduced, the panel wrote:

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"There is not yet published evidence from randomized clinical trials that confirms the reduction or elimination of risk of HIV transmission [with anti-HIV therapy]."

Moreover, the panel highlighted recent findings that showed that HIV has been detected in the semen of men and genital secretions of women despite suppressed HIV in the blood because of therapy. Obviously this poses a risk for transmission.

The panel reminds health care providers that they have a role to play when it comes to initiating discussion about safer sex. The panel goes on to say that an undetectable viral load in the blood does not mean that there is also an undetectable viral load in genital fluids. Furthermore, despite the use of anti-HIV therapy, HIV infection can occur during unprotected sex.

Since STIs help increase the risk of transmitting HIV -- by inflaming tissue, causing sores and lesions -- doctors should regularly question their patients about symptoms possibly caused by STIs and regular lab testing for these germs is necessary.

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This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication TreatmentUpdate. Visit CATIE's Web site to find out more about their activities, publications and services.
 
See Also
Read the Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents
More News and Analysis on HIV Treatment Guidelines


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