Hiv Treatment As Prevention
Treatment as prevention refers to taking HIV medication to prevent the sexual transmission of HIV. It is one of the highly effective options for preventing HIV transmission. People living with HIV who take HIV medication daily as prescribed and get and keep an undetectable viral load have effectively no risk of sexually transmitting HIV to their HIV-negative partners.
TasP works when a person living with HIV takes HIV medication exactly as prescribed and has regular follow-up care, including regular viral load tests to ensure their viral load stays undetectable.
Can You Have Hiv For 11 Years And Not Know
A person with HIV may experience mild symptoms, such as swollen glands, in the first few years after infection. People who are not aware they are HIV-positive may not realize they are infected because the symptoms of HIV can be mild at first. HIV can be spread without even knowing it is present in them.
I Want More Information
For more information on the U=U campaign and the science behind U=U, visit Prevention Access Campaign.
Visit our U=U for advocates page for more in-depth resources and information.
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A Controversy About Hiv Transmission
Many HIV experts have recently become embroiled in a new controversy: Does an undetectable viral load translate to significant reduction in HIV transmission during sex? If so, are condoms necessary? What message should be imparted by physicians to their patients who confront this situation in their daily lives?
In January 2008, an important and prestigious panel of experts from the Swiss Federal Commission for HIV/AIDS boldly produced the first-ever consensus statement saying that HIV-positive individuals on effective antiretroviral therapy and without sexually transmitted infections are sexually non-infectious. This opinion was also published in the Bulletin of Swiss Medicine . Hotly discussed at the International AIDS conference in Mexico City this summer, it was soon followed by a rejection statement by a joint Australasian group of experts.
In laymen’s terms, this means that barebacking among HIV-infected persons who are on the cocktail who have undetectable viral load, would not transmit HIV to their partners.
If Im Undetectable Is There A Chance My Viral Load Will Become Detectable Again
Being undetectable does not mean that you are cured of HIV. There are three instances when your HIV viral load might come back and be detectable again.
The most common instances are so-called viral blips. Blips are when your HIV levels become slightly detectable, but at a very low level, and then goes back to being undetectable again. People may experience viral blips when they take their HIV medications every day. Viral blips are usually due to issues in the lab, such as some slight error in the test or in the test conditions in the lab. Occasionally they are due to a slight but true increase in the viral load due to a stress such as an illness or a vaccine. Viral blips, in which the viral load goes right back down to undetectable soon, are considered harmless. There is no appreciable chance that a person with a viral blip will transmit HIV to another person.
People also become detectable when they stop taking their HIV medications or take them only partially. It may take between a week to several weeks after stopping HIV treatment for HIV to become detectable again, but people will see the levels of virus in their body go up to detectable levels.
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Why Isnt My Medical Provider Telling Me This Information
Unfortunately, some medical providers are not up-to-date with the current science. Others agree with the science but are concerned about 1) an increase in condomless sex among people with HIV which may result in an increase in other STIs 2) patients potential lack of understanding that maintaining an undetectable viral load requires excellent treatment adherence and monitoring and 3) if people with HIV interrupt their treatment by choice or circumstances outside of their control, their virus will likely rise to detectable levels. Some medical providers selectively choose to discuss this information only with patients and clients whom they judge are responsible rather than directly address the concerns described above through education. There is no medical or ethical justification to withhold this information. It is essential for medical providers to inform their patients about the benefits of treatment.
How Often Should Viral Load Testing Be Done
According to the United States Health and Human Services clinical HIV guidelines, patients on a stable, suppressive ARV regimen, viral load should be repeated every 3 to 4 months or as clinically indicated to confirm continuous viral suppression. Clinicians may extend the interval to 6 months for adherent patients whose viral load has been suppressed for more than 2 years and whose clinical and immunologic status is stable. In high-resource countries, providers are increasingly conducting viral load testing on an annual basis.
The World Health Organization guidelines, most often followed in low and middle income countries, however, note on page 148, Routine viral load monitoring for early detection of treatment failure: obtain and review result by 6 months after ART initiation, 12 months after ART initiation and yearly thereafter.
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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?
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!
Do I Still Need To Use Condoms If Im Undetectable
Some couples decide that they want to stop using condoms once they or their partner are undetectable. Its important to remember that although theres no HIV risk, being undetectable doesnt prevent you from getting or passing on other sexually transmitted infections or stop unwanted pregnancies, so you will have to use other measures to avoid these.
If you do stop using condoms, its important that both you and your partner are comfortable with the decision. It can help to talk it through with a healthcare worker first. Its recommended that you have a least two viral load tests confirming that youre undetectable before relying on this for HIV prevention. If your partner is HIV-negative they may consider using PrEP as an extra precaution.
In couples where both partners are living with HIV, its important that you are both undetectable before deciding not to use condoms. This is because if one partner has a different strain of HIV or has developed drug resistance this can be passed on if they have a detectable viral load.
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Does Hiv Viral Load Affect Getting Or Transmitting Hiv
Yes. Viral load is the amount of HIV in the blood of someone who has HIV. Taking HIV medicine daily as prescribed can make the viral load very lowso low that a test cant detect it .
People with HIV who take HIV medicine daily as prescribed and get and keep an undetectable viral load have effectively no risk of transmitting HIV to an HIV-negative partner through sex.
HIV medicine is a powerful tool for preventing sexual transmission of HIV. But it works only as long as the HIV-positive partner gets and keeps an undetectable viral load. Not everyone taking HIV medicine has an undetectable viral load. To stay undetectable, people with HIV must take HIV medicine every day as prescribed and visit their healthcare provider regularly to get a viral load test. Learn more.
About Undetectable And Hiv
Chances are youve probably heard of the term undetectable, undetectable viral load or UVL when chatting to friends or potential sexual partners, on apps or social media, or in blogs, magazines and medical journals.
But, what does it mean?
Having an undetectable viral load not only improves a HIV positive guys overall health, but it also means he wont transmit HIV to his partners. When a HIV positive guy is on treatment, within six months he can, in most cases, achieve an UVL.
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Testing Positive On Nucleic Acid Tests
In addition to antibody tests, we also have HIV tests that detect viral RNA not necessarily live virus, but parts of the virus genetic material. These are called nucleic acid tests, and they are able to detect very early HIV infections. These tests are not used as often for screening as antibody tests , because results take longer and the test is more expensive. Usually, RNA tests are used to confirm an HIV positive diagnosis after someone tests positive on an antibody test or to see if a person is responding well to treatment.
Some of these viral detection tests are able to detect virus at very low levels. Some research HIV RNA assays can measure HIV RNA levels down to the single copy levels.
We commonly say someone is undetectable if they have a viral load less than 20 copies/mL or 50 copies/mL. Research studies have defined undetectable as any viral load less than 200 copies/mL.
So even if a person has a viral load less than 50 copies/mL or 20 copies/mL, viral RNA will still be detected with one of these viral detection tests.
Are Breastfeeding Guidelines Changing For Mothers With Undetectable Viral Load
In light of U=U, researchers and clinicians in high-income countries are calling for a better understanding of HIV infection via breastfeeding. There also remain concerns around treatment toxicity in infants, as antiretroviral treatment is present in breast milk of mothers, as well as the effect of inflammation in the mammary gland, such as mastitis, which can increase HIV shedding in breast milk.
But we know that breastfeeding has multiple benefits over formula feeding for the baby, such as anti-inflammatory effects, improvements in the babys immune system, improvement in the development of the gut microbiome, and better overall health and psychological outcomes in the long-run.
While no high-income countries explicitly recommend breastfeeding, treatment bodies in the US and in European countries such as the UK and Switzerland now call for a human-rights centred approach, which advocates for mothers to be counselled about breastfeeding and the risks, and supported if they wish to exclusively breastfeed and are virally suppressed.
So until our understanding of the science improves, guidelines are unlikely to recommend breastfeeding for mothers with an undetectable viral load in high-income countries any time soon.
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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.
Undetectable Viral Loads And Transmission
The Swiss expert statement had been originally downplayed in the media for fear of encouraging more unsafe sex. One applauds the Swiss for encouraging individuals to get tested and begin effective treatment, thereby slowing the transmission of the virus within the community. The Swiss statement and referenced studies, however, were also criticized due to being heterosexually based and debated as to its application to the MSM population or gay community. But it also generated irrational fear that HIV transmission would get out of control.
Hence the Australasian rejection and conclusion of only the strict use of condoms plus early treatment of STIs being the only means to reduce transmission of HIV. However this continues to beg for further debate. It is fruitless to ignore that effective antiretroviral therapy eliminates HIV from genital secretions, and that HIV RNA, measured in sperm, declines below the limits of detection on antiretroviral therapy. HIV RNA also falls below the detection limits in female genital secretions during effective antiretroviral therapy. Moreover, usually sperm cell viral particles rise only after an increase in viral load from the blood. The cell-associated viral gene particles, present in genital secretions during effective antiretroviral therapy, are actually non-infectious virions HIV-containing cells in sperm lack markers of viral proliferations such as circular LTR-DNA.
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Cdc Backing Could Help Lessen Stigma
Misinformation, stigma, and fear around HIV remains prevalent.
People diagnosed with HIV overestimate the risk of infecting their HIV-negative partner. Even though only 10 percent of participants in a recent survey had non-suppressed viral loads, a third of respondents believed their chance of infecting a partner was high, according to AIDSMAP.
We hope the CDCs endorsement of this fact helps lessen the stigma that still exists around people living with HIV, and that it encourages an open dialogue between sexual partners about their status, treatment, and prevention methods, said Sawyer.
Prevention Access Campaign has been a leader in education around the issue with the U=U campaign.
Advocates also hope the CDCs backing will provide additional leverage for challenging state nondisclosure laws, which criminalize HIV-positive people who dont disclose their HIV status.
Sawyer pointed out, The CDCs acknowledgement is a further indication that our laws around nondisclosure are no longer supported by the current accepted science and research about HIV transmission.
I Am Hiv Negative My Partner Has Been Undetectable For Over 6 Months And Now We Want To Have A Baby Why Does Our Doctor Say I Should Take Prep
The research on HIV transmission risk in couples trying to conceive when the HIV-positive partner is durably virally suppressed is still limited. If you are HIV negative and are trying to get pregnant with an HIV-positive partner’s sperm, it is generally recommended that you be on PrEP, regardless of your partner’s viral load. This is, however, a clinical judgment and a decision you and your doctor should make considering what is best for you, your partner, and your future child.
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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.
Do I Need To Disclose My Hiv Status To My Sex Partner If I Am Undetectable
As long as you have an undetectable viral load and you continue to take your ART as prescribed you are not putting your sex partners at risk. It is a highly personal decision whether or not to share your status with a partner. There is no single right answer to whether there is an ethical duty to share your status when you are not putting your partner at risk. However, you may want to consider the pluses and minuses of sharing your status for you and your partner. A partner may become upset if they learn about your status after sexual interaction and it can cause unnecessary interpersonal consequences even when several scientific studies have proven that there is no risk of transmission. Also, its extremely important to keep in mind that many discriminatory HIV criminalization laws exist in some states and parts of the world that require you to disclose your status even when there is no risk of transmission. To learn more about the HIV criminalization laws in your state and country, visit HIV Justice Network.
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Does The Law Say I Have To Tell My Partner About My Hiv Status
If youre having protected sex theres no law saying you must tell your partners that you have HIV. Its your choice whether you tell them or not.
However, in England and Wales theres a risk of being prosecuted for reckless transmission of HIV if:
- you had sex with someone who didnt know you had HIV
- you knew you had HIV at that time
- you understood how HIV is transmitted
- you had sex without a condom, and
- you transmitted HIV to that person.
The law in Scotland is largely the same, except that a case can also be brought if transmission hasnt taken place but someone has been put at risk of transmission without their consent or knowledge.