Viral load and transmission - an information sheet for people with HIV

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virus fond blancThe amount of HIV in your body fluid is called your viral load. Effective HIV treatment (antiretroviral therapy) suppresses the amount of HIV in your body fluids to the point where it can not be detected by the tests used in the clinic. Doctors call this "virologic suppression," but it is often known as "having an undetectable viral load" or "undetectable."

Having an undetectable viral load does not mean you are cured of HIV. This does not mean that you should stop doing treatment. This means that, while maintaining its undetectable viral load, you dramatically reduce your chance of passing HIV to another person.

Viral load at different stages

During the first two weeks after a person contracts HIV, viral load is usually very high - usually several million copies per milliliter of blood (copies / ml). This is a significant opening of risk of HIV transmission at this point, and many people acquire HIV from someone who has only recently acquired HIV (and may not know it).

After this period of early infection, the viral load usually falls. A typical viral load in someone who is not having treatment can be 50.000 copies / ml. There is also the risk of transmitting HIV. (Translator's note: The mine was in over three million soon after diagnosis)

When someone starts HIV treatment, viral load usually becomes undetectable within six months. The risk of HIV transmission is very low when people have an undetectable viral load.

The proof

In 2011, a major scientific essay called HPTN 052 found that HIV treatment reduced the risk of transmitting HIV to regular heterosexual partners in 96%. The only reason it was not 100% is that a person got HIV, but this happened only a few days before or after your partner started treatment.

A note from the British HIV Association (BHIVA) and the AIDS Expert Advisory Group (EAGA) stated that if the HIV-positive partner succeeds in HIV treatment it is "as effective as the consistent use of condoms" in limitation of transmission. The statement emphasizes that regular viral load tests are vital and it is advisable to wait six months after the first undetectable viral load test to make sure the treatment is working.

The BHIVA / EAGA statement is only applied to vaginal sex because there were not a sufficient number of homosexual couples in the HPTN 052 to show whether the treatment reduced the risk to the same extent in anal sex.

In 2014, a study called PARTNERS did not find a single HIV transmission in 16.400 relationships between homosexual and heterosexual men where 28.000 among HIV-positive partners had a viral load below 200 copies / ml (note that viral load is considered undetectable below 40 copies of viral RNA per thousand of blood). In 2015, a similar study exclusively of male gay couples, Opposites Attract they also did not find partner transmissions with an undetectable viral load. Both studies are collecting more data and will have definitive results in 2017.

What this means to me?

A large number of people with HIV infectivity see reducing and alleviating anxiety about the transmission as a very important benefit of HIV treatment. You may wish Vector biohazard icon virustake your viral load and its likely infectivity into account when thinking about safer sex.

If you want to stop using condoms, it is important to discuss this carefully with your partners and ensure that they feel equally comfortable with the decision. Discussing what an undetectable viral load means with HIV-negative partners can help reduce your anxiety about HIV transmission. However, this information will probably be new to most people who do not have HIV; this can take time for someone to understand and can trust what you are saying. (Editor's note: Bring the person to this site, on this page and have them read this text)

Knowing how HIV treatment can reduce the risk of transmitting the virus can be especially helpful for people who wish to have a child. Couples in which one person has HIV and the other does not, you might consider the possibility of having unprotected sex on days when the woman is most fertile.

It is important to remember that while HIV treatment will protect your partners from their HIV, it does not protect them from other sexually transmitted infections (ists). In addition, in some countries, sex without disclosing their HIV status is a criminal offense regardless of the likelihood of HIV transmission.

If I start HIV treatment, how long it takes for my viral load is undetectable?

It can take up to six months. Until then, you can still be contagious. It is a good idea for you and your partners to wait until your viral load becomes undetectable for at least six months prior to any decisions about whether to stop using condoms - or stop using PrEP (pre-exposure prophylaxis).

Treatment of HIV always work?

About one in six people in their first treatment or never have an undetectable viral load or its treatment for work in the first year. During the second year of treatment, the chance of your treatment stops working is about one in twenty and this continues to decline over the next decade to about one-in-fifty chance of failure in any one year. So the longer you are on a special treatment for HIV, less likely to stop working. And almost everyone reduces their viral load to an undetectable level in their second or third scheme.

If treating someone does not result in undetectable viral load, this usually occurs because it is having trouble taking their treatment as prescribed, ie, it does not take all the pills on time without missing doses.

People with an undetectable viral load never transmit HIV?

It is difficult to prove that people with an undetectable viral load not transmit HIV. One study found that the lowest viral load in someone who transmitted HIV was 362 copies / ml, although this person was not on treatment. There have been three reports of transmissions involving homosexual men who had an undetectable viral load close to time of transmission, but we do not know if they had an undetectable viral load at the time HIV was transmitted.

Not the sperm viral load, most important vaginally or rectally fluid than the viral load in blood?

Viral load in blood and other body fluids is generally very similar - if HIV in your blood is undetectable, it is likely to be detectable anywhere else. Sometimes people have detectable HIV in the blood and have low levels of HIV in body fluids, but rarely in infectious levels.

And what, after all, about sexually transmitted diseases (STDs)?

If you are not on treatment, some DSTS may make HIV more contagious: for example, syphilis can double your viral load. The HIV-negative partners are also more likely to get HIV if they have an STI. However, under study, there was no single transmission of HIV, although many people had STIs.

Translated from original Viral load and transmission - a factsheet for people with HIV by  Claudio Souza and Revised By Mara Macedo

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