Undetectable ≠ No risk of HIV transmission
The published results from the HPTN 052 study as well as an increasing amount of talk around treatment as prevention have opened up a new avenue of questioning for HIV positive members of society. Some think that having an undetectable HIV viral load means that you can’t transmit HIV to others.
Agreeing or disagreeing with this mindset is not easy and takes a lot of information.
Although it is documented that the subjects of 052 with an undetectable viral load did not transmit HIV, lets not forget that all the study participants received prevention counseling that included free condoms.
Where they used? Who knows?
Nothing in life is 100% risk free. Getting out of bed in the morning comes with some amount risks.
A case study from Germany involving a 39-year-old man in a monogamous relationship, on ART since 2000, with a viral load <50 copies/mL over a period of over 4 years. The patient was in good health, good treatment adherence and no other STIs. In May of 2003, he and his partner of 3 years began having unprotected anal sex. His partner had tested HIV negative in 2002. In July of 2004, his partner seroconverted. Testing ruled out that the HIV came from a 3rd person.
So Undetectable does not necessarily mean non transmissible.
We can all agree that ART and an undetectable viral load significantly reduce the risk of HIV being transmitted; but it does not eliminate the possibility.
Shedding, (which is a spike in virus) in the male genital tract happens even in men with consistently undetectable blood viral loads. We still don’t know the genital tract viral load needed to transmit HIV. So risk reduction is necessary.
Recommending safer sex practices for HIV infected is the best bet to prevent HIV transmission.
Gilbert Mallais
Treatment Information Facilitator/ Info-traitement Co-coordinator
Stürmer et al. Case report: Is transmission of HIV-1 non-viraemic serodiscordant couples possible? Antivir Ther 2008;13:729.