What Is Effective Treatment
We are using the term effective treatment to mean that someone is on treatment, taking it as prescribed and has an undetectable viral load. In the UK this is usually classed as a viral load below 20 copies/ml.
The Partners PrEP study found that there remains a transmission risk within the first six months of treatment as the HIV positive partners viral load takes time to come down.
Therefore effective treatment means someone has been taking it as prescribed for at least six months and has an undetectable viral load.
Over 90% of people diagnosed with HIV in the UK are on effective treatment and undetectable, and therefore are not infectious .
Do I Still Need To Worry About Other Sexually Transmitted Infections
Neither HIV treatment nor PrEP prevents other sexually transmitted infections, or STIs.
Ways to reduce the risk of STIs include having both partners tested, limiting the number of sexual partners and using condoms. Vaccines are available to prevent some STIs, including hepatitis B and human papillomavirus .
How Does Being Durably Undetectable Affect My Risk Of Transmitting Hiv To A Sexual Partner
People living with HIV who take antiretroviral medications daily as prescribed and who achieve and then maintain an undetectable viral load have effectively no risk of sexually transmitting the virus to an HIV-negative partner.
Three large multinational research studies involving couples in which one partner was living with HIV and the other was notHPTN 052, PARTNER and Opposites Attractobserved no HIV transmission to the HIV-negative partner while the partner with HIV had a durably undetectable viral load. These studies followed approximately 3,000 male-female and male-male couples over many years while they did not use condoms. Over the course of the PARTNER and Opposites Attract studies, couples reported engaging in more than 74,000 condomless episodes of vaginal or anal intercourse.
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Myth : It Is Obvious When Someone Has Hiv/aids
There is no way to tell with a naked eye whether a person does or does not have HIV. If someone contracts the virus, their symptoms may be undetectable for decades, they may even be HIV-free on some tests.
Sometimes, a person with HIV may display symptoms that are similar to a common cold like fever, headache, fatigue. Many people have no symptoms at all.
The stereotypical notion of being able to tell if someone has the virus comes from the early days of AIDS diagnosis. These are the symptoms of complications from AIDS-related sicknesses. That said, these symptoms will never be present in someone who receives antiretroviral treatment daily.
Can I Trust That My Partner Is Really Undetectable
Just like you cannot tell if someone has HIV or is taking PrEP by looking at them, you also cannot tell if someone has an undetectable viral load by how they look. Whether or not you choose to trust your partner is a highly personal decision and is likely to depend upon your sexual practices and relationship circumstances. People engaged in consensual sex are responsible for their own sexual health. In some circumstances, PrEP is an empowering option to protect yourself against HIV transmission without having to depend on others. If all parties agree, attending a medical visit with your partner and getting viral load info from the provider can be a way to increase trust.
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What Is A Realistic Possibility Of Transmission
Persons living with HIV have a duty to disclose their HIV status before sex that poses a realistic possibility of transmission. This legal test determines when non-disclosure invalidates consent to sexual activity in other words, when the law will deem after the fact that the HIV negative partner did not consent, even though she or he may have consented at the time of sexual activity.
The SCC held that there is no realistic possibility of transmission where the person living with HIV had a low or undetectable viral load at the time the sexual activity took place, and a condom was used . The SCC also acknowledged that advances in medical treatment of HIV may narrow the circumstances where there is a duty to disclose HIV positive status. The most recent medical science on HIV transmission is therefore relevant to determining if there was a realistic possibility of transmitting HIV.
Ways Hiv Cannot Be Spread
HIV is not spread by:
- Air or water
- Mosquitoes, ticks or other insects
- Saliva, tears, or sweat that is not mixed with the blood of a person with HIV
- Shaking hands hugging sharing toilets sharing dishes, silverware, or drinking glasses or engaging in closed-mouth or social kissing with a person with HIV
- Drinking fountains
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More Sensitive Viral Load Testing
In NSW we now have more sensitive viral load testing, which means laboratories across the state can detect small amounts of the virus as low as 20 copies/mL. For HIV positive guys this means that they may see some change from their previous viral load readings from below 20 copies/mL a new, potentially higher number. This should not be a cause for concern as any viral load of 200 copies/mL or less is still considered undetectable. A person with this level of viral suppression cannot transmit HIV to their partners, however if you still feel concerned, we recommend speaking with your doctor.
How Will I Know If I Am Undetectable
You cant tell if you have an undetectable viral load simply by how healthy you look and feel. The only way to know that your viral load is undetectable is by regular viral load monitoring.
Viral load monitoring involves a simple blood test to measure how many particles of HIV there are in a small sample of your blood . From this you and your healthcare worker can understand how well your ART is working.
A low viral load means that your ART is working well and controlling your HIV. If you have an undetectable viral load, it means that the amount of HIV in your body is so low that you can’t pass it on to other people through sex.
The point at which a viral load is classified as being undetectable may vary across different countries depending on the tests available. But so long as your viral load is under 200 copies per millilitre, youre considered virally suppressed and unable to pass HIV on.
The frequency with which you are offered viral load testing may vary depending on where you are and the services available to you. The World Health Organization recommends that when first starting ART, you should have your viral load measured after the first 6 months of treatment and again at 12 months. After becoming undetectable you should still receive viral load testing at least every 12 months. Depending on the resources available and your particular health status, your health worker may recommend that your viral load is monitored more often than this.
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What Will Being Undetectable Mean For Me
Having an undetectable viral load means that your ART is effectively controlling your HIV. This will protect your immune system and help you to stay in good health.
Being undetectable also means that you dont have to worry about passing HIV onto your sexual partners. For many people this is just as important to them, giving them relief from the anxiety of passing HIV on. Some people find that knowing theyre undetectable makes it easier to with others, as it can be reassuring for others to know that your health is protected and you cant pass it on too.
What Does Treatment As Prevention Mean
Treatment as prevention refers to any HIV prevention method that uses ART to decrease the risk of HIV transmission to a sexual or needle-sharing partner, or through vertical transmission . ART reduces the HIV viral load in the blood, semen, vaginal fluid, breastmilk, and rectal fluid to very low levels, and as a result reduces HIV transmission. TasP is the foundation for U=U. TasP does not indicate the amount of reduction in the risk or the level of viral load required to prevent transmission. U=U builds upon TasP by indicating the the level at which there is no risk of transmitting HIV sexually. Dr. Julio Montaner pioneered the concept of TasP in 2006.
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Hiv Undetectable=untransmittable Or Treatment As Prevention
In recent years, an overwhelming body of clinical evidence has firmly established the HIV Undetectable=Untransmittable, or U=U, concept as scientifically sound. U=U means that people with HIV who achieve and maintain an undetectable viral loadthe amount of HIV in the bloodby taking antiretroviral therapy daily as prescribed cannot sexually transmit the virus to others. Thus, treatment for HIV is a powerful arrow in the quiver of HIV prevention tools. Read more about how a durably undetectable viral load prevents HIV transmission with NIAID’s fact sheet 10 Things to Know About HIV Suppression.
For nearly two decades, scientists have recognized that viral load is a key determinant of HIV transmission. Studies conducted before the availability of ART revealed that higher viral loads correlate with higher rates of both sexual and perinatal transmission of HIV. Following the advent of triple-drug ART in 1996, observational studies suggested that viral loads lowered by ART were associated with reduced risk of sexual and perinatal HIV transmission. In addition, epidemiological studies showed that as the number of people in a community who are virally suppressed rises, the number of new HIV transmissions falls.
To read more about the underlying science and the value of U=U, see NIAIDs blog post Science Validates Undetectable=Untransmittable HIV Prevention Message.
Studies Prove Hiv Therapy Can Erase The Risk Of Infecting Others
Ever since the human immunodeficiency virus was first discovered in 1983, scientists have worked ceaselessly to find ways to prevent the further spread of the disease. Some of the interventions, like condoms, are effective but far from foolproof. Others, like pre-exposure prophylaxis , are over 90% effective but have been poorly embraced by many high-risk groups, including African Americans. It was only in 2019 that scientists finally revealed the one intervention that can effectively reduce the risk of HIV to zero: an undetectable viral load.
The strategy, referred to by public health officials as “Undetectable = Untransmittable” , is based on evidence that antiretroviral therapy in people with HIV can altogether prevent infection if the viral load is fully suppressed.
According to research, a person with HIV cannot infect others if there is no circulating virus in semen, blood, or other bodily fluids.
It is a strategy that had been long debated prior to the release of the PARTNER 2 study 2019 and the earlier PARTNER 1 study in 2016. The landmark studies, which involved 1,570 gay and heterosexual serodiscordant couples provided what health officials declared was the first sure-fire way to prevent transmission even when condoms were not used.
Despite the definitive results, there are some limitations to the U=U strategy, namely the low rate of undetectable viral loads among Americans living with HIV.
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What Does Negligible Risk Mean
Negligible risk means so small or unimportant as to be not worth considering insignificant, having effectively no risk of sexually transmitting the virus. For U=U, “risk” is a projection talking about chances of something happening in the future and cannot be quantified, or given an exact number. What can be said for sure is that there have been zero transmissions in studies so far. And those studies included tens of thousands of unprotected sex acts. Undetectable individuals do not transmit HIV sexually, so the risk of transmission is negligible.
How Is Pep Different From Prep
PrEP and PEP are both forms of HIV prevention for people who are HIV-negative. A big difference between PrEP and PEP is that PrEP is taken before potential exposure, while PEP is taken after possible exposure to HIV. While PEPis prescribed in emergency situations and should be taken within 36 hours of exposure, PrEP is a daily pill that people can take to protect themselves against HIV if they think they will be sexually exposed.
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What Does It Mean To Be Undetectable
HIV medication works by reducing the amount of the virus in the blood to undetectable levels. This means the levels of HIV are so low that the virus cannot be passed on. This is called having an undetectable viral load or being undetectable.
It can take up to six months for some people to become undetectable from when they start treatment.
PARTNER 1 and PARTNER 2 studies provide robust evidence for gay couples and heterosexual couples that the risk of HIV transmission with suppressive ART is effectively zero, which supports the message of the international campaign, U=U .
How Long Do I Need To Be On Art And Be Undetectable In Order Not To Transmit Hiv
First, being on ART and being undetectable are two different things. When you start on ART, it takes a while for the medication to do its job. Generally, if the ART is working, it should reduce the amount of virus in your blood to an undetectable level within a few months. Once you are undetectable , you then need to stay undetectable for at least six months before your HIV is considered “untransmittable.” In other words, you need at least two confirmatory tests that your viral load is less than 200 copies/mL – at the beginning and the end of a six-month period – before you can use your undetectable status as a method of HIV prevention.
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How Variable Is An Undetectable Viral Load Can This Change Over Time
HIV specialists have decades of experience managing antiretroviral therapy and are confident that you can remain uninfectious as long as you:
- take your medication every day as prescribed, and
- have your viral load checked regularly.
The presence of other sexually transmitted infections can potentially affect viral load, but in the PARTNER study there were no HIV transmissions even when other STIs were present. Those results held through the PARTNER 2 trial as well.
It is however important to remember that HIV treatment can only be successful if you have access to it and are taking it as prescribed.
Can My Viral Load Continue To Change
Yes, your viral load can continue to change. This would usually be a result of factors to do with your adherence , or other health issues. Regular viral load monitoring will help you stay on top of these changes, so you can manage your health accordingly.
Your viral load usually drops quickly after first starting treatment, however it may be a while before it reaches a point where its undetectable. Most people who adhere properly to their treatment become undetectable after about six months, but its important that you have a viral load test to confirm this.
While changes to viral load can occur, they should be relatively uncommon for people who adhere properly to their medication and are otherwise in good health. Your viral load monitoring appointments are there to help you to identify and respond to any changes in your viral load.
These appointments also give you time to discuss any difficulties you are having with your medication. Often big life changes, like starting a new relationship or moving to a new place, can make adherence more difficult. Your healthcare worker can help you with any new challenges and work with you to stay healthy and keep your viral load low.
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Thats Good News For All
Undetectable viral load is game-changing news for both poz and neg guys. If youre HIV poz, undetectable comes with amazing health benefits as well as the assurance that you are keeping the guys you play with safe.
And if youre neg, having sex with a poz guy whos undetectable can give you the confidence that you wont get HIV. UVL puts safety first for everyone.
After I Begin Hiv Treatment How Long Does It Take For The Risk Of Sexually Transmitting Hiv To Become Effectively Zero
There is effectively no risk of sexual transmission of HIV when the partner living with HIV has achieved an undetectable viral load and then maintained it for at least six months. Most people living with HIV who start taking antiretroviral therapy daily as prescribed achieve an undetectable viral load within one to six months after beginning treatment.
A persons viral load is considered durably undetectable when all viral load test results are undetectable for at least six months after their first undetectable test result. This means that most people will need to be on treatment for 7 to 12 months to have a durably undetectable viral load. It is essential to take every pill every day to maintain durably undetectable status.
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What Does U=u Mean For Me If I Dont Have Hiv
You dont need to be afraid of getting HIV when your sexual partner is undetectable. As stated in the NAM aidsmap resource Undetectable viral load and transmission information for HIV-negative people, If you have a partner with HIV who is on treatment and has an undetectable viral load, they will not pass HIV on to you even if you dont use condoms. However, if you have other sexual partners, you could still contract HIV outside the relationship, possibly from someone who does not know that they have HIV. In these instances, prevention methods such as condoms or PrEP may still be important. It is important to remember that while an undetectable viral load will prevent transmission of HIV, it does not protect you or them from other sexually transmitted infections or unwanted pregnancy. Condoms are highly effective at preventing STIs. Condoms and other birth control options may be considered to prevent pregnancy as well.