The chance of an HIV-positive person with undetectable viral load transmitting the virus to a sexual partner is scientifically equivalent to zero confirmed in the 22A International AIDS Conference (AIDS 2018) in Amsterdam today. The final results of the PARTNER study were presented this morning at a press conference on the opening day of AIDS 2018. The results originally announced in 2014 the first phase, PARTNER 1, already indicated that "Undetectable is equal to non-transmissible" (U = U). However, the statistical certainty of this result was not as convincing in the case of gay men, nor in anal sex as in vaginal sex.
The results of PARTNER 2, the second phase, which only recruited gay couples, were presented today.
The results of PARTNER 2, the second phase, which only recruited gay couples, were presented today.
The results indicate, in the researchers' words, "A precise rate of transmission within the couple of zero" for gay men, as well as for heterosexuals.
The PARTNER study recruited serodiscordant couples for HIV (a positive partner, a negative partner) in 75 clinical sites in 14 European countries. They tested HIV-negative partners every six to 12 months for HIV and tested the viral load on HIV-positive partners. Both partners also completed behavioral research. In cases of HIV infection in the negative partners, your HIV was genetically analyzed to see if it came from the usual partner.
The study found no transmissions between homosexual couples where the HIV-positive partner had a viral load lower than 200 copies / ml - although there were almost 77.000 acts of sex without a condom between them.
Why Does The Partner Matter? !!!!! ????
Partner Matters, And It Matters A Lot!
And That For The Simple Fact That We Can not Know Where He Or She Was During Those Ninety Minutes Of Telephone Off Or "Out Of Service Zone" (Sic)!
What if something happened that caused you to have an Ultra Recess?
There are reports of "strains like this !!!!!!!!!!"
For those who think that I travel in the mayonnaise I make it clear that I made a Trocadalho do Carilho
It is appropriate for PARTNER 2 results to appear on the tenth anniversary of a passionate debate at the International AIDS Conference in Mexico City in 2008 on the validity of the Swiss Declaration, which was the first published document to state that circumstances, people with HIV who have completely suppressed viral loads due to treatment can not transmit HIV.
At the time, it was said that because of the lack of viral load monitoring in anything but high-income countries, this - even if true - would have little relevance to most people with HIV.
There was also concern that telling people with HIV that they were not infectious if they were suppressed by viruses would be counterproductive because it would discourage safe sex. The most important message to be given to people, according to some experts, is that they should take every dose of their therapy. This is sensible. But there is one simple detail:
In practice, the theory is different.
A I = I (IndetectaVel equal to Intransmissible) campaign was founded as a reaction to these positions.
This thought I support! And I know that my support or "I do not care" matters globally, but I take care of 20.000 users who come here almost every day and, if they come here, they listen to me. The problem with this I = I is that, I know very well how much it costs to persuade a person to use the condom and I will shortly tell a case of rape where I, yes, I, I was a victim. I was forced to do what I did not want, with whom I did not want to, in an abominable situation where, after more than eighteen months without being sexually touched - I told you, I believe, that after the diagnosis I was six months without receiving a hug, think about it - and in that situation, faced with the impossibility of avoiding the biological reaction, contained, repressed, boiling and impossible to be stopped I asked for the use of the condom and she said (in absolute ignorance):
-You do not have anything and if you have, you already fucked everything (the penetration, in her sick mind was fatalism of contagion and, see: It was, or is, a program girl, and if you attacked me like that without a condom ...
And that is exasperating! People, in general, know a person and end up, when it works (or wrong, I do not know) going to bed.
- This time with a condom
- I'm not sure yet
- Oh, that's nothing. better die of AIDS than Vont'AIDS
I've been told this here, and people who know me know that at this time I can only think of a flaming spear or a chainsaw.
Nothing, nothing, nothing, nothing nothing and nothing else can be as idiotic as "precept". Curiously, all the people who came to me over these years with this philosophical orientation came in two distinct types of people:
- Those diagnosed, terribly sorry and frightened
- And the undiagnosed ones, with the neura of the window, terribly sorry and frightened.
Sounds familiar? If you talked to me, I'm sure you did.
The thought behind I = I is that telling people they are not infectious if viral suppression is a message of hope and something seriously desired by many people with HIV. It would help fight the stigma against them and their own self-stigma. By providing a powerful incentive for treatment, it could also have a positive impact on public health as well as on individuals.
Swiss physicians who released the original 2008 statement apologized at a time when claiming that people "do not" transmit HIV in the above circumstances were too definite, and that they only meant to indicate that the probability of transmission was reduced.
But what PARTNER tells us is that they were right all along. People who are suppressed by viruses not transmit HIV.
It was widely assumed at the time that sexually transmitted infections (STDs) could make people infectious even when they normally had undetectable viral load.
But PARTNER 2 tells us that STI infections have no impact on HIV infectivity in people who are totally repressed.
And it was thought that because HIV is transmitted more easily via anal than vaginal sex, the results may not be valid for gay men.
But PARTNER 2 now tells us that I = I is as strong for gay men (and for anal sex) as for heterosexuals.
What "zero" means
"Zero" needs an accurate explanation. When lead researcher Alison Rodger announced the results of the first phase of the study, PARTNER 1, in 2014, she said, of the risk of transmission by an undetectable partner, that "Our best estimate is, it's zero."
By "estimate," she meant that it is impossible to prove that something will ever happen. So researchers use confidence intervals. These do not indicate what the results show, but what they can exhibition. They define how accurate your findings are.
In the first announcement of the PARTNER 1 data, concerns were expressed because what is called the 'upper limit of the 95% confidence interval' was 0,45% for all but 0,84% for any sex among gay men and 4% for sex receptive anal with ejaculation.
The% 0,45 means that if you had to run the PARTNER 1 20 times, it would be more likely that, once out of those 20 replicates of the study, you would find an HIV transmission in each 222 couple if you followed them for a year - or a broadcast on any pair if you followed them for 222 years. The 4% would increase this probability to one in each 25 couple per year (or one transmission every 25 years per couple).
It is important to note that these may not be actual events. The confidence interval is a statement about "noise", and so is a statement both about the chances of losing a transmission (a false-negative) as on the odds of mistakenly "seeing" a transmission that is not real (a false positive).
The fact that the upper limit for anal sex was higher than for all sex was not due to the fact that anal sex transmits HIV more efficiently than the vaginal. It was because there were fewer couples who had anal sex - so the resolution of the findings was smaller, like a picture with fewer pixels.
Especially, it did not mean, as some people understood, that the probability of transmitting an anal sex partner without undetectable condom, where the positive partner was insertive and ejaculated, was 4%. Nevertheless, the but probability of transmission was zero.
But since there were fewer homosexual couples than heterosexual couples in the 1 PARTNER, it was decided to recruit more couples to narrow the confidence intervals for anal sex between men. These new couples, in addition to the original PARTNER 1 homosexual couples, formed the PARTNER 2 cohort.
About PARTNER 1 and 2
PARTNER 1 was carried out between September of 2010 and May of 2014 and PARTNER 2 of May of 2014 to April of 2018. There were 888 couples in PARTNER 1, 337 of them (38%) gay couples. In PARTNER 2, other 635 gay couples were recruited, making a total of 972 gay couples and heterosexual 516 throughout the study.
Not all of these couples provided what is called a "few years of follow-up" (CYRUs) throughout the study period. Couples only contributed to the data if they had had intercourse without a condom since the last data were collected if the HIV-positive partner maintained a viral load below 200 copies / ml and if the seronegative partner did not use the pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP).
This meant that 783 male / male couples ended up providing 1596 couple-years of data, with an average time eligible within the 1,6 study years. Couples reported on average 43 sex acts without a condom per year.
At the beginning of the study, the mean age of HIV-negative partners was 38 and seropositive, 40. They reported having had condom-free sex with each other for an average of one year before joining the study. HIV-positive partners were on antiretroviral therapy for an average of four years. Ten percent of the negative partners and 14% of the positive partners were diagnosed with an STI during the study.
The 1596 couple years, containing an estimated total of 76.991 sexual acts without a condom, did not produce any transmission between partners. There was 15 new infections - but three quarters of them reported recent sex without a condom with a different partner, and transmitted HIV genotyping showed that no infection came from the regular partner; six had a completely different subtype of HIV. In total, 285 HIV-negative men (37%) reported sex without a condom with other men.
These new data allowed the researchers to estimate much narrower confidence intervals. The upper limit of the 95% confidence interval for all sex without condom in any PARTNER is now of 0,23%. And the upper limit for receptive anal sex with ejaculation is 0,57% - quite close to the upper limit for todos os sex in PARTNER 1.
What this means is: if you conducted the PARTNER 20 study times, there is a greater than normal chance that you would lose a real transmission (or would see a fake) in 435 couples followed by a year - or a transmission in a couple followed for 435 years. (mere statistics)
And if you repeated the study using only the 19.836 estimated occasions of the seronegative partner to be receptive, and the ejaculate seropositive partner, you would lose a real transmission (or would see a false one) once in 175 couples in a year - or once in 175 years in a couple.
It is very unlikely that these, to repeat, reflect the true probability of transmission - they are statements about the probability that the observed zero transmissions do not reflect reality. It remains the case that the most likely likelihood, by far, of an HIV-positive person with a viral load less than 200 copies / ml being able to infect his or her partner is zero.
The researchers were also able, for the first time, to calculate the upper limit of the 95% confidence interval for risk of transmission in which one of the partners had an IST. This is greater at 2,74%, or 5% chance of seeing (or failing) one transmission per couple every 35 years - but, again, the most likely risk is zero, and the only reason why this zero is "inaccurate "Is because 6301 was only estimated occasions of sex without condom (of any type) in which one of the partners had an IST.
PARTNER is not the only study on viral load and infectivity. Last year, THERE IS THE STUDY opposites attract study also found no broadcasts on almost 17.000 acts of anal sex without condom among gay serodiscordant partners, which means that no transmission was seen in 126.000 about sex occasions if you combine this work with PARTNER 1 and 2.
What has changed is that we can now affirm that I = I with at least as much confidence for gay men as we already can for heterosexuals or, as researchers say, "The PARTNER 2 provides a similar level of trust for gay men and heterosexual couples in the PARTNER 1. "
"We looked a lot for broadcasts," Alison Rodger told aidsmap.com. "And we did not find any."
The last line on the last slide she presented today was"Indetectavel = Inon transmissible "
RodgerA et al. Risk of HIV transmission through unsafe sex in gay couples with suppressive ART: The PARTNER 2 study expanded the results in gay men. 22a International AIDS Conference, Amsterdam, abstract WEAX0104LB, 2018.
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