Undetectable in Blood May Not Be Undetectable in Semen
Undetectable = Non-transmissible? You'd better read!
A study of 101 gay men at the Fenway Health HIV clinic in Boston (Politch) found that a quarter of men with undetectable viral loads in their blood, however, had detectable HIV in their semen.
Although seminal viral load in these men has been low (mean 200 copies / ml), the researchers suggest that this is still sufficient to be one of the explanations for continued transmission in gay men, despite a high proportion of antiretroviral therapy.
There was a very strong association between detectable HIV in semen and a current sexually transmitted infection (STI). Six of the eight men whose HIV was undetectable in blood, but detectable in semen (called viral discordant), had a urethral STD. After adjusting for other factors, the researchers concluded that men who had an STD and / or urethritis were 29 times more likely to have viral discordance.
In the Boston study, participants averaged 43 years and three quarters were white. All were on antiretroviral therapy (ART) for more than three months and 80% for more than a year.
Nearly three quarters were considered HIGHLY RISK OF CONTRAIRING A STD BECAUSE THEY HAD SEVERAL SEXUAL RELATIONS IN THE LAST THREE MONTHS. Because it's not just AIDS that we talk about. We talked about:
- Hepatitis C
- Gonorrhea (which is becoming, due to this type of ABUSE - In the case of antibiotics - Incurable)
Anyone who has ever had gonorrhea knows how it feels to urinate volcanic lava through the urethra! (I.e.
Nine of the men were diagnosed with an STD (gonorrhea, syphilis, chlamydia or non-gonococcal urethritis - it hurts as I say) and 24 had leukocytospermia or white blood cells of the immune system in the sperm, indicative of urethral inflammation.
Eighteen of the 101 men had a detectable viral load in their blood; its median viral load on blood plasma was 560 copies / ml and ranged between 80 and 640.000 copies / ml. Nine of these 18 males also had detectable HIV in their semen (50%).
OF 83 MEN UNLIKE HIV DETECTABLE IN BLOOD, 21 (25%) HAD HIV DETECTABLE IN SEMEN. THE MEDIUM SEMINAL VIRAL LOAD IN THESE MEN WAS FROM 200 COPIES / ML AND VARIOUS FROM 80 TO 2560 COPIES / ML.
In addition to having an STD, in the multivariate analysis, two other factors remained strongly associated with the detection of HIV in the semen in men without blood in the semen. Elevated levels of the inflammatory cytokine TNF-α were associated with a greater 14 risk of seminal discordant viral load, and had unprotected anal insertive sex (being 'ACTIVE'), which was associated with a risk more than seven-fold higher
An 2008 study from San Francisco (Butler) found that the mean seminal viral load in men transmitting HIV to partners was only 4300 copies / ml and the lowest was 110 copies / ml.
And by another route in an 2009 study from Brighton in the UK (Fisher) found HIV infections in gay men who compared by genotyping revealed that two of the 41 HIV transmissions (5%) were from men with a seemingly undetectable viral load.
However, studies of linkage between viral load and transmission find it difficult to locate transmitters in a cohort of gay men with multiple partners where viral load could only be measured months after transmission (in the Butler study, the mean difference between transmission and viral load was 103 days).
An interesting aspect of this study was the higher risk of seminal viral load associated with unprotected insertive sex. Researchers suggest that urethritis in these HIV-positive homosexuals may be caused by infections with fecal bacteria acquired during anal insertive sexual intercourse or even that the virus detected may have been passively passed on to viruses of other HIV-positive homosexuals.
In any case, this would tend to increase the infectivity of HIV-positive men if they had insertive sex with negative men. And I, Claudius, must remember that it is not uncommon, whether by shame, or even (why not say it?) Perversity, they can lie to researchers and doctors!
I've done it in the past! Sometimes sometimes out of shame, on certain occasions even by not trusting the "Clinical Entity present from me, visibly impacted by the Megalonamic Deity Syndrome
And I've already read about it and, I apologize, I did not have time to translate these texts, but I'll do it sooner or later, it's my way of being
... as well as the 'low risk' heterosexual men in 16
If STDs are linked to seminal HIV, it can be assumed that men of low infective risk with undetectable HIV blood levels would not have it in their semen.
However, another study from France (Lambert-Niclot), with HIV-positive heterosexual men in stable relationships who sought sperm lavage, found that 20 of 304 men (6,6%) had HIV in their seminal fluid.
The study was longitudinal, with 304 heterosexual men who attended a clinic in France in search of sperm washing for conception between 2001 and 2011. Among these men among 628 provided paired samples of blood and semen, HIV was detected in 107 blood samples (17%) and 49 seminal samples (8%). During this period, 20 participants (6,6%) provided at least one paired sample in which HIV was undetectable in blood (below 40 copies / ml) but detectable in semen. Seminal viral load ranged from 135 to 2365 copies / ml in these samples. Can you afford it?
The proportion of men with a discordant seminal viral load did not vary over time, despite the development of more sophisticated and potent HIV regimens.
Both studies caution that men with undetectable viral load results should not assume that they are non-infectious and should be warned that HIV treatment does not appear to reduce the risk of HIV transmission to zero.
Eum Claudius, I consider the posture of thinking myself undetectable as non-transmissible as reckless on my part.
And this way ....
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