HIV and Friends, Part 2 — Is an Undetectable Viral Load Safe?

Jim Burroway

January 31st, 2008

The Swiss seem to think so:

The Swiss National AIDS Commission said patients who meet strict conditions, including successful antiretroviral treatment to suppress the virus and who do not have any other sexually transmitted diseases, do not pose a danger to others. …

The Swiss scientists took as their starting point a 1999 study by the U.S. Centers for Disease Control and Prevention, which showed that transmission depends strongly on the viral load in the blood. The Swiss said other studies had also found that patients on regular anti-AIDS treatment did not pass on the virus, and that HIV could not be detected in their genital fluids.

“The most compelling evidence is the absence of any documented transmission from a patient on antiretroviral therapy,” said Pietro Vernazza, head of infectious diseases at the cantonal hospital of St.Gallen in eastern Switzerland and one of the authors of the report.

I have seen a few references to this hypothesis in medical journals — I call it a hypothesis because I haven’t ever heard of a study to test the hypothesis — but I’ve never before seen anyone go out on a limb to say that unprotected sex with someone with an undetectable viral load is safe. And I won’t. As I understand it viral loads can fluctuate for a variety of reasons, including if the person has the cold or flu or any other temporary illness.

I normally wouldn’t even comment on this hypothesis except it has now appeared in the mainstream media. If I were you, I’d demand a whole lot more proof before changing any behaviors. My advice here still stands.

Update: The CDC has responded to the Swiss actions by reiterating their previous recommendations.

See also:
HIV and Friends, where we discuss the ethics of revealing someone’s HIV status and the pernicious role stigma plays in the assumptions surrounding those living with HIV/AIDS.
HIV and Friends, Part 3 — Where Ignorance Rules. If the Swiss believe that HIV isn’t contagious under certain conditions, a Judge in Ontario believes HIV is so dangerous it can be transmitted simply by sharing the same courtroom with someone.

Timothy Kincaid

January 31st, 2008

Can HIV be transmitted if the virus cannot be detected?

That’s a question worth asking.

If it can be proven that anti-retroviral drugs can prohibit the passing of the virus, it would be conceptually possible to end this virus in one generation.

It would involve a very intrusive program of testing all persons who might even possibly be a carrier. And it would involve an enormous expense of providing anti-retroviral drugs to an enormous population of people – mostly in the third world where cost, distribution methods, and cultural barriers might make it virtually impossible.

But there would be hope for an end of this plague.

I agree that it is NOT time to dismiss or disregard safe sex guidelines. But nonetheless it would be good news. And it just might provide a workable solution that we could eventually plan towards.

ondamaris

February 1st, 2008

well it’s just a bit more than a hypothesis…
my post on the swiss statement is in german, sorry: http://www.ondamaris.de/?p=1175

but the swiss statement in german http://www.saez.ch/pdf_d/2008/2008-05/2008-05-089.PDF and french (… pdf_f …) available.

an english-language article on the swiss statement can be found at nam http://www.aidsmap.com/en/news/4E9D555B-18FB-4D56-B912-2C28AFCCD36B.asp citing some of the studies done …
greetings from berlin ;-)

ondamaris

February 1st, 2008

and, by the way, the swiss statement does of course NOT disregard safer sex – it just says there are certain circumstances under which other possibilities exist … (eg for straight couples wishing to have childs)

Amber

February 16th, 2010

I am married to an hiv positive man for 4 years and we have 4 children together. We had sex regularly and i’m still negative to this day.

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