There is life with HIV

Are you undetectable? Yes? How nice! And your pair? ...

Free Sex: what the research says about risk when your viral load is undetectable

1Having undetectable viral load is a goal that must be pursued. My wife and I had our undetectable viral load in just over six months. This has remained for us for almost fifteen years. My wife had a viral blot of 20.000 copies, which remained so for three months. She had to take fuseon while the "Maraviroc" protocol did not happen and fortunately recovered and been undetectable for at least ten years, and after retiring her CD4 has been going up, she was in 750, after, in a sad past , be close to 200 and I believe the next exam will give even better news. Although I post, by official duty, the position that it is possible to have unprotected sexual intercourse with a seropositive patient, in treatment, with an undetectable viral load, I advise and advise women, who only accept this relationship with the use of condoms ... As my father says, who told me and did very little in life, "a dog bitten by a snake is afraid of sausage" Article deals with research on treatment as prevention (TasP), an effective method of HIV prevention.But noIt does not promote fickle sex or provides comments about when people should use condoms or not. When used consistently and correctly, condoms protect against HIV, as well as protection against many other sexually transmitted infections that can contaminate you and complicate even the Viral load is undetectable.

 Learn more about how condoms work to prevent HIVOn a page translated automatically and without human review. In the not too distant future I will translate it.

John and her husband have stopped using condoms for several years - even if John is living with HIV and her husband is HIV negative. John's husband is not in PrEP or PEP. How would John's husband remain HIV-negative and why do not any of them need to worry about HIV transmission?

John and his partner rely on an HIV prevention method calledTreatment as prevention (TasP).

Viral load is undetectable
Undetectable? Condom prevents unplanned pregnancy and there is no PrEP for Hepatitis C or other STIs

It may seem complicated, but in reality, it is very simple. It works. By taking your HIV medications regularly so that your viral load is "undetectable," John can stay healthyeProtect the health of her husband. This is because HIV-positive people in whom the viral load is less than 40 do not transmit HIV to others. Editor's note: Broadly speaking. Doubts? ***Second person contracts rare strain of HIV despite being on PReP***

Editor's note: I particularly find this way of living extremely dangerous because there are variables, such as "viral blip", for example, and the relatively small application of studies regarding the safety of this in women, I and the broad lines are treated in a way that I feel the lack of relevance or even a "certain" lack of consideration and, if we look well, women are physically, biologically and socially more vulnerable to HIV by N factors, like the abominable practice of Sthealting, where the "gentleman"

"We stopped using condoms sometime after 2008," said John. "I worried, a little first, [about HIV transmission], but we do not worry any more. I have been living with HIV since before 1988 and probably managed to be undetectable in 1997. I have not been detected today. "

John and her husband have very little reason to worry about HIV transmission. For a long time, health care providers and researchers suspected that people living with HIV on treatment who maintained undetectable viral loads probably would not transmit HIV to anyone else. But recently, very large clinical studies have shown that people on treatment, who maintain undetectable viral loads, do not transmit HIV to sexual partners.

Here's what we know about effective treatment as prevention - and why we know it works.

TasP works for heterosexual couples when viral load is undetectable

1
Teenage couple with one (now look at !!!) positive test for pregnancy

A study published in 2011 in the New England Journal of Medicine was the first large-scale study to provide definitive proof that treatment as prevention works - at least for heterosexual couples. (The final results of the study were published in 2016.)

The study,Called HPTN 052, Was designed to answer two questions: First, is it better for people living with HIV to initiate antiretroviral therapy immediately for health reasons? And secondly, can antiretroviral therapy suppressing HIV replication prevent sexual transmission of HIV? The answer to both questions, the study found, is resounding YES.

The study included 1.763 serodiscordant couples (different HIV infection status) in Africa, Asia and the United States, with an average follow-up time of more than 5 years. Said another way, this was a long study with many people.

About half of the people living with HIV in the study were invited to start antiretroviral therapy immediately, while the other half were asked to delay HIV treatment until two CD4 counts were followed below 250 cells / mm3. (This study was started on 2005, before doctors knew it was best to start HIV treatment as soon as possible).

The researchers looked at the difference in the number of new HIV infections that occurred in couples who were on HIV therapy versus those who were not. Before concluding the study in May of 2011, the researchers found that people in the ART study reported a reduction of 96% in the risk of HIV transmission to the partner than people who were not yet in ART. Therefore, the safety and data monitoring framework for the study altered the study protocol - so that all those living with HIV in the study received ART.

Throughout the study, ART was associated with a lower 93 risk of HIV transmission. A total of 43 HIV infections occurred in couples when the HIV-positive person postponed their HIV treatment. Only 3 HIV infections occurred in couples when the HIV-positive person started ART immediately. (This includes only HIV infections that were genetically linked - that is, those in which the HIV infection was found to come from the study partner.) It is believed that none of the people who transmitted HIV to a partner were burdened suppressed at the time the transmission occurred. (The editor says: Very convenient this claim rs, rs)

"If people are taking their pills responsibly and taking them for a period of time, the likelihood of transmission in this study is really zero," said Myron Cohen, MD, principal investigator of the HPTN 052 study, inAn interview with magazine Plus.


The problem, says the editor of this site, is that you can not trust HIV and AIDS, a question of poor quality of life or even death, in someone else's responsibility to take pills!

HPTN 052 had a large and immediate impact when the results of the study first emerged, with experts announcing the results as "innovators" and "milestone" for HIV prevention and treatment. Treatment policies and guidelines around the world have begun to change after HPTN 052 results are available. Evidence that early treatment not only improves the health of people living with HIV, regardless of how high or low their CD4 counts are, but also prevents HIV transmission, causing health agencies to recommend treatment of HIV. For all people living with HIV.

"This breakthrough is a serious game changer and will drive the prevention revolution. This makes HIV treatment a new priority prevention option, "said Michel Sidibé, Executive Director of the Joint United Nations Program on HIV / AIDS (UNAIDS) at 2011." We now need to ensure that couples have the option of choosing Treatment for Prevention And Have Access To It ".

TasP works for men who have sex with men when the viral load is undetectable

After the HPTN 052 results came, experts theorized that HPTN 052 results can also be applied to peopleBesidesHeterosexual people with vaginal sex. But many people who do not have vaginal sex, including men who have sex with men with anal sex, have wondered if treatment as a prevention would also work for them.

"At the individual level, there is no reason to think that successful treatment also does not reduce the risk of HIV transmission to gay and bisexual men (and others who engage in anal sex). However, it is still unclear whether this reduction will be as large as it was for heterosexual couples in the HPTN 052 study (who were primarily involved in vaginal sex). Even if the risk reduction is the same for gay and bi men, the risk of HIV transmission during treatment may still be higher for anal sex than for vaginal sex, "Wrote James Wilton of CATIE em 2013.

John remembers a doctor telling him there was little risk of him being infectious because his viral load was undetectable in the early 2000 years. Still, he felt there was not enough evidence to justify this statement. John assumed that the risk of transmitting HIV to his partner was low because he was undetectable, and because his partner was the "top". Still, he remembers not being completely sure that he would probably not infect his partner until the results of a study called PARTNER have been released in 2014.

The first results of thePARTNER studyBegan to provide definitive answers for men who have sex with men. Definitely showing that gay men who maintain an undetectable viral load do not transmit HIV to sexual partners.

The PARTNER study included men who have sex with men and heterosexual people in serodiscordant relationships who were not using condoms, taking PrEP or in PEP. People living with HIV suppressed viral loads (less than 200 copies / mL). The study was large, with 888 couples providing data and divided 75 clinical locations in 14 European countries.

Of the 340 couples of men who have sex with men, the researchers had data from 1.238 pairs of years of follow-up combined. The men in the study reported a median of 42 sexual acts without condominium per year, with more than 22.000 unsafe sexual acts reported during the study.

The researchers followed this group of serodiscordant pairs over time to track the HIV infections that occurred and ask the men about the type of sex they were having.

Over the almost four years of the study, ten men acquired HIV. Interestingly, none of them acquired HIV from their HIV-positive, undetectable primary partner.

In other words, HIV infections occurred during sex with someone who was HIV positive, but not on treatment or otherwise not repressed by virus. The researchers were able to verify this by comparing the genetic strains of HIV from those who tested positive during the study, with the HIV strain their partners had (and in all 10 cases, the strains did not match).

Since there were no linked HIV transmissions, the researchers estimated thatThe risk of HIV transmission with an HIV-positive partner with ART with viral load less than 200 copies / mL was zero.This was true for men who have sex with men during insertive sex, receptive sex, receptive sex without ejaculation, and receptive sex with ejaculation.

"Based on the number and type of sexual acts and the cumulative probability of HIV transmission, more than 100 transmissions would be expected if the HIV-positive partner had not taken ART," the researchers said, demonstrating how effectively HIV therapy could be Preventing new transmissions.

The researchers rated their results by saying they "can not provide a direct answer to the question of whether it is safe for serodiscordant couples to practice sex without a condom," and that more data will be needed to determine what the margin error is in the zero estimate . (For receptive anal sex with ejaculation, there was a greater margin of error due to the lower number of reported sexual acts in general).

The bottom line

We now have conclusive evidence that maintaining an undetectable viral load prevents the transmission of HIV to sexual partners. For many people, this new biomedical method of HIV prevention offers a renewed sense of freedom, brings less anxiety about sex and reduces stigma associated with HIV.

"I think people today have a lot of confidence in the fact that it is possible to have a serodiscordant relationship and make it work," John said. "Nowadays, if someone wants to use a condom, I will respect their preferences. But I do not feel like it's something I'm forced to do now. I do not feel like I'm putting someone at risk by having sex with them. "

Translated by Cláudio Souza from the original in English in

Emily Newman

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