Does Hiv Treatment Always Mean People Have An Undetectable Viral Load
Not everyone taking HIV treatment has an undetectable viral load. After starting HIV treatment, it can take as long as six months for a persons viral load to become undetectable. Until then they may still be infectious. The British HIV Association recommends that you and your partner should not make any decisions about stopping using condoms until their viral load has been undetectable for at least six months.
When starting HIV treatment, some people find that the first prescribed drugs dont work well for them. But nearly everyone finds a combination that works and the risk of treatment failing declines over time.
People with an undetectable viral load sometimes experience what are called blips in their viral load. Their viral load increases from undetectable to a low but detectable level before becoming undetectable again on the next test.
This should not be a cause for concern. In the PARTNER and Opposites Attract studies, undetectable was defined as below 200 copies/ml. These studies showed that transmission does not occur below this level.
What Does This Mean For Me
‘Undetectable equals Untransmittable’ has been a life-changing finding for many people living with HIV. It means that if you are on effective treatment with an undetectable viral load, you do not have to worry about passing on HIV through sex, even if you do not use a condom.
This has helped many people living with HIV have more fulfilling sex lives and less anxiety around sex.
Knowing that ‘Undetectable equals Untransmittable’ is especially useful for people wishing to have a child. Couples in which one person has undetectable HIV and the other is HIV negative can have unprotected sex in order to conceive.
However, the law on HIV may not have caught up with the science. In some countries, condomless sex without disclosing your HIV status is a criminal offence, regardless of the likelihood of HIV transmission. For information on specific countries, visit our page on criminalisation laws around the world.
“For as long as your viral load stays undetectable, your chance of passing on HIV to a sexual partner is zero.”
How Well Does The Use Of Hiv Treatment To Maintain An Undetectable Viral Load Prevent The Sexual Transmission Of Hiv
Research conducted in serodiscordant couples shows that consistent and correct use of HIV treatment to maintain an undetectable viral load is a highly effective strategy to prevent sexual HIV transmission for both heterosexual and same-sex male couples. Evidence from this research shows that when people are on successful treatment and engaged in care they do not transmit HIV through sex.
Results from a large two-phase observational study known as PARTNER/PARTNER2 showed that treatment and an undetectable viral load prevents sexual HIV transmission in both heterosexual and same-sex male couples in the absence of other forms of HIV prevention . The first phase of the study included heterosexual and same-sex male couples, and the second phase continued with only same-sex male couples. In this study there were many unprotected sex acts when the HIV-positive partners viral load was undetectable approximately 36,000 among heterosexual couples and 76,000 among same-sex male couples enrolled in the study. By the end of the study, there were no HIV transmissions between couples in the study when the HIV-positive partner was on treatment and had an undetectable viral load. However, 16 new HIV infections were transmitted from a sex partner outside of the relationship.
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If I Am Hiv Negative And My Hiv
In the age of U=U, prevention and safer sex now means an undetectable viral load, condoms, PrEP, or a combination of these, depending on your needs and feelings. If your partner is undetectable, they cannot transmit HIV through sex. However, your decisions about condoms should be based on your sexual behavior and your partner sexual behavior. Remember that U=U only protects against HIV transmission! Condoms are still the best way to prevent STIs and pregnancy. If you are HIV negative and have other partners, you should consider and condoms or emergency PEP . However, if you are in a monogamous relationship and your partner is undetectable, you could choose not to use any other forms of protection. It is very important to have an open and honest conversation with your sexual partner and your doctor about which prevention methods are right and most comfortable for you.
Viral Load At Different Stages
During the first few weeks after someone gets HIV, viral load is usually very high typically several million viral copies per millilitre of blood . There is a considerable risk of passing on HIV at this point. In fact, many people acquire HIV from someone who has only recently acquired it themselves .
After this period of early infection, viral load usually drops. A typical viral load in someone not taking treatment may be 50,000 copies/ml. There is still a considerable risk of passing HIV on.
After starting HIV treatment, viral load usually falls rapidly. Within three to six months, most peoples viral load has become undetectable.
Most clinics in the UK report a viral load as undetectable if it is below 20-50 copies/ml. However, if your viral load remains below 200 copies/ml , there is no risk of passing HIV to your sexual partners. There is no need to worry if your viral load goes slightly above the detection limit of 20-50 copies/ml.
detectable viral load
When viral load is detectable, this indicates that HIV is replicating in the body. If the person is taking HIV treatment but their viral load is detectable, the treatment is not working properly. There may still be a risk of HIV transmission to sexual partners.
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What Do I Need To Know About Hiv Transmission
It is important to take safety precautions to prevent the transmission of HIV. HIV is an infection that slowly weakens your immune system. Over time, a weak immune system makes it difficult for you to fight infections. Common signs and symptoms of HIV infection include chronic diarrhea, weight loss without trying, and skin rashes or lesions.
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How Can Service Providers Improve The Uptake And Correct Use Of Hiv Treatment And An Undetectable Viral Load To Prevent The Sexual Transmission Of Hiv
Educational and counselling activities for people whether they have HIV or are at risk for HIV should include information on the HIV prevention benefits of treatment and an undetectable viral load, along with information on the other highly effective ways to help prevent HIV. These include PrEP, PEP, condoms for sex and new equipment for using drugs. Encourage clients to choose the combination of strategies that will work most effectively for them as there are multiple approaches to HIV and STI prevention that can be combined in different ways. Discuss how the use of HIV treatment to maintain an undetectable viral load fits into a comprehensive plan for sexual health including regular STI testing and safer sex practices.
Education and counselling on the use of this HIV prevention strategy should include a discussion about the large body of evidence showing that people on HIV treatment who maintain an undetectable viral load do not transmit HIV through sex. Education should also include the factors necessary for maximizing the effectiveness of this strategy. Emphasize the following:
You can also lead or support efforts to improve awareness of the use of HIV treatment to maintain an undetectable viral load as a prevention approach among a range of service providers in your area including doctors, nurses, pharmacists and non-clinical staff at community-based organizations.
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How Do I Talk To My Partner About Their Risk Of Acquiring Hiv
People living with HIV can involve their partners in their treatment plans. Research shows that adhering to treatment often can improve with support from loving relationships and from the community.
Pre-exposure prophylaxis , in which an HIV-negative person takes antiretroviral medication to prevent infection, can be part of the conversation. Learn more about PrEP.
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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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.
No Risk Of Hiv Transmission Really
So is it true that if a HIV positive partner is on treatment and has a UVL sustained , then there is no risk of HIV transmission?
Yes!
In 2016, the PARTNER study from Europe found that the chance of HIV transmission where one partner had a UVL is negligible. In fact, there were zero partner-transmissions recorded in the study despite approximately 22,000 acts of condomless sex by gay couples. Additionally, PARTNER2 the extension study of PARTNER that aimed to gather data pertaining to mixed-HIV-status gay male couples found that after an additional 54,000 acts of condomless sex there were zero transmissions.
This is also supported by a large international study, led by the Kirby Institute here in Australia, the Opposites Attract study, which focused solely on gay and other men who have sex men from Australia, Brazil and Thailand, confirmed that HIV positive men who are on treatment and have an undetectable viral load do not transmit the virus to their partners.
So, between these two studies there has was a combined total of over 89,000 acts of condomless sex occurred between gay couples with zero transmissions!
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How Does U=u Address Stigma
Since the beginning of the HIV epidemic, PLWH have been seen by many as “infectious”, feeding widespread discrimination and the unfortunate internalization of shame and stigma . HIV-negative people feared starting relationships with people living with HIV, and sex with a person living with HIV was seen as a possible health risk to the HIV-negative partner. U=U presents an opportunity to silence those damaging narratives by breaking the link between sex and HIV transmission.
How Do I Know If My Viral Load Is Undetectable
The only way to know if your viral load is undetectable is through an HIV viral load or HIV RNA test that your doctor or health care provider can do. You will need to have your blood drawn for this test, and the test will determine the level of virus in your blood that day. If the level of virus in your blood is below the limit of detection of the test, then we say your virus is undetectable.
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Undetectable: Your Burning Questions Answered Get An Hiv Doctors Answers To Your Burning Questions About Undetectable Viral Loadand What It Means For Your Health And Your Sex Life
In 2013, BETA published an article about viral suppression and having an undetectable viral load. A lot has changed since the original article was published.
To keep us up-to-date, Barry Zingman, MD, the medical director of the AIDS Center at Montefiore Medical Center and professor of medicine at Albert Einstein College of Medicine joins us to answer our questions about what it means to be undetectable, the risk of HIV transmission, and more.
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.
Learn more about HIV treatment as prevention.
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How Do We Know That U=u What Is The Evidence
The evidence for U=U comes from several groundbreaking research studies and clinical trials. A study called HPTN 052, a randomized control trial to find out if ART can stop transmission of HIV in sero-different couples, enrolled more than 1,700 sero-different heterosexual couples who were randomly assigned to have the HIV-positive partner either immediately start ART or delay the start of ART. Over time, results among study participants showed no linked transmissions when the index partner was suppressed.
Another study, the PARTNER Study, which was carried out at 13 sites in Europe, had specific enrollment eligibility criteria that included undetectable sero-different couples who had condom-less sex. In what were a reported 58,213 sexual encounters during this study, there were no transmissions linked to the HIV-positive partners. In the summer of 2017, at the International AIDS Conference in Paris, the results of the Opposites Attract study were reported. It studied 358 gay male sero-different couples and found no linked HIV transmissions in nearly 17,000 condom-less sexual acts.4
The findings from these three key studies show that not only does being on effective antiretroviral treatment improve the health of each person with HIV, it also keeps them from transmitting HIV to sexual partners.
Hiv: How Its Not Transmitted
The following are nine ways the virus is not spread:
Kissing and touching. Social kissing and hugging pose no risk of transmission, Sha says. Also, being sexual with someone without exchanging infected body fluids does not spread the virus. The only time deep kissing is a risk is when the person infected with HIV has open sores or oral bleeding, Sha notes.
Sharing a living space. Any casual contact with someone who has HIV, including sharing a bathroom, is safe. However, Sha tells patients not to share razor blades or toothbrushes. If someone who is infected nicks himself while shaving or has bleeding gums, it could increase risk of transmission.
Sharing food or utensils. The virus cannot survive on surfaces, so sharing utensils and other household items will not spread HIV. You can even share a meal with someone who is infected without worry. Transmission has been associated with mothers pre-chewing food for their babies, when infected blood from the mouth mixes with the food. Known as pre-mastication, it is a common practice in Africa, but not typically done in the United States, Sha says.
Saliva, sweat, or tears. An infected persons saliva, sweat, and tears do not put you at risk.
Water fountains. Sipping from a water fountain after someone who has HIV used it is considered casual contact and will not lead to transmission.
Mosquitoes and other insects. The virus is not viable in insects or ticks, Sha says.
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How Often Should I Have My Viral Load Checked
A key part of U=U is remaining engaged in ongoing medical care. If you are using your undetectable status as an HIV prevention method,, it is advisable that you check with your doctor and consider having your viral load tested with the frequency they recommend. No matter what your HIV status is, your sexual health is important and deserves regular attention. If your partner is on pre-exposure prophylaxis , consider scheduling your quarterly medical visits at similar times. If either of you has other sexual partners, these quarterly visits are a good chance to get checked for sexually transmitted infections and keep up to date with your other health screenings.
How To Prevent Transmission
Between 2% and 6% of adults infected with hepatitis B virus will develop chronic hepatitis B. Chronic hepatitis B can lead to liver failure and liver cancer, so protecting yourself is important.
The hepatitis B vaccine is safe for almost everyone and about 95% effective for providing long-term protection against hepatitis B infection.
While anyone can benefit from the vaccine, people who are at a greater risk of being exposed to the virus because of their work, lifestyle or medical history are strongly encouraged to be immunized. In many countries, babies born to infected mothers get vaccinated at birth. All babies born in the United States are routinely vaccinated.
Hepatitis B immune globulin , is another way to prevent hepatitis B infection in babies born to infected mothers or after exposure to the virus. This uses concentrated antibodies to provide immediate protection. According to the Centers for Disease Control and Prevention, it is given as a shot and can provide short-term protection against hepatitis B.
Because the hepatitis B vaccine does not protect against HIV, hepatitis C or other diseases spread through sex and contact with blood, itâs still important to keep using basic protective strategies. Practicing safer sex and not sharing needles are recommended even if youâre immune to hepatitis B.
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