No one with undetectable viral load transmitted HIV in Partner Study
The second largest study to look at whether people with HIV become noninfectious if they are under antiretroviral therapy (ART) found no cases where someone with a viral load below 200 copies / ml of HIV transmitted by anal or vaginal sex.
A statistical analysis showed that transmission via anal sex was more likely. And someone successfully treated for HIV was 1% per year. E of 4% for anal sex with ejaculation where the HIV-negative partner was passive.
However, the true probability is probably much closer to zero than that.
When asked what the study told us about the chance of someone with an undetectable viral load.
Lecturer Alison Rodger said, "Our best estimate is zero."
However, I Claudius, I would not feel so calm! I would need, always and necessarily the condom.
I even admit that for me, it is already a "late pudding".
Participants had undetectable viral load
Study HPTN 052, Undetectable Viral Load and HIV Transmission
In view of the fact that the previous study HPTN 052, established in 2011 that the efficacy of antiretroviral therapy in reducing HIV transmission from the HIV-positive partner to HIV-negative was at least 96% in heterosexual couples but had very few gay couples in the study to thereby establish if the same applied to them (or instead of anal sex).
O PARTNER study was created to remedy this knowledge gap. And so far, he has recruited 1110 couples, where partners have sorodivergent status, and approximately 40% of them are gay couples. And I suggested you can take advantage of it and open it in another flap this matter: How Long Until You Begin to Pass HIV to Others?
To participate in this study, couples must be doing sex without condom at least part of the time.
The HIV-negative partner may not be using pre- or post-exposure prophylaxis (PEP or PrEP).
And the HIV-positive partner has to be in Antiretroviral Therapy (ART), with the most recent viral load below 200 copies / ml.
This study is different from the HPTN052 effectiveness of HIV-positive partners initiating the therapy (versus partners who had not started).
In total, 767 couples participated in this two-year interim analysis and there were a total of 894 contraceptive follow-ups.
Among heterosexual couples, the HIV serostatus was divided in equal parts.
And in half of the couples the man had HIV and the other half, the woman.
Gay couples were keeping sex without a condom with undetectable viral load
Some couples were excluded from the analysis. In most cases, this was because they did not show up at the follow-up appointments. But in 16% of cases, it was because the HIV-positive partner developed a viral load above 200 copies / ml.
And in 3% of cases because the HIV-negative partner took PEP or PrEP.
There were significant differences between gay couples and heterosexual couples. At the baseline, gay couples were having sex without a condom for a shorter average period:
1,5 years versus 2,5 for heterosexual men and 3,5 for women.
Hiv-Negative Partners Heterosexuals With Undetectable Viral Load Reported to Have Made Vaginal Sex Without Condom, 72% With Ejaculation
During the follow-up period, all heterosexual HIV-negative partners reported having had vaginal intercourse without a condom.
- 72% with ejaculation;
- 70% of HIV-negative gay partners reported passive anal sex,
- 40% with ejaculation,
- While 30% only reported being the active partner.
A significant proportion of heterosexual couples reported having had anal sex (will be reported later).
In this way, sex without a condom outside of the relationship was much more common among gay men!
One-third of HIV-negative partners reported this, versus 3-4% of heterosexuals.
There is no doubt that because of this, sexually transmitted infections (STIs) were much more common in gay couples.
And so, surprisingly, an index with 16% of gay men developing an STI (especially gonorrhea or syphilis) during follow-up.
These numbers versus 5% of heterosexuals.
The results of unprotected intercourse with undetectable viral load
The main news is that the PARTNER until now there has been transmission in couples with a partner with an undetectable viral load, as was estimated to 16.400 occasions of sex in gay men and heterosexual in 28.000.
Although some of the HIV-negative partners became HIV-positive (the exact number will be revealed at a later analysis), genetic HIV tests revealed that in all cases the virus came from someone other than the primary partner.
Alison Rodger told the conference that the HIV-positive partners were not in treatment in this group, 50-100 (average: 86) transmissions would have been expected in gay couples, and 15 transmission in heterosexual couples.
Viral Load Undetectable and No transmission is not the same as zero chances of transmission
No transmission is not the same as zero transmission chances. The researchers calculated the confidence intervals of 95% for the observed results.
What this means is that they calculated the probabilities of zero transmissions being the 'true' fact and what was the maximum risk of transmission.
I give the results observed.
They established that there was a chance that 95% (in a couple where sexual activity is average for the study group) the largest possible risk of transmission of a partner was 0,45% per year and anal sex 1% per year .
At a press conference, Dr. Jens Lundgren, principal investigator of the PARTNER study, pointed out that this meant that there was a maximum chance of 5% that in a period of 10 years.
One in each 10 partner in a gay couple who had unprotected anal sex could get HIV;
Equally so, it was more likely that their chances of contracting HIV from their partners were close to zero, and in fact could be zero.
Maximum Likelihood Of Transmission Of Someone In Hiv Suppressive Therapy In Its Highest Degree Era Of 2% Per Year
As the group the studied group becomes smaller, the greater the confidence intervals become and the certainty of a result becomes 'vague'.
This means that the maximum probability of transmission of someone in HIV suppressive therapy to its highest degree was 2% per year for anal sex with ejaculation.
2,5% for passive anal sex
E 4% for passive anal sex with ejaculation.
This latter fact implies more than a three-fold chance of infection if sexual behavior remains unchanged for more than ten years, but again, this is one of the 'worst' scenarios and the probability is probably smaller.
Thus, no transmission occurred despite relatively high levels of STIs, especially in gay couples.
When the Swiss Statement was released on 2008, it stated that people with an undetectable viral load did not transmit HIV.
However, it made an exception in people with STI: The PARTNER study may be telling us that STIs (in positive or negative partners) do not increase the likelihood of HIV transmission.
That is if the positive partner is in ART and undetectable (although, of course, it can still be transmitted to them).
Undetectable Viral Load Has Reduced Risks*
PARTNER is recruiting gay men's couples and, as noted above, your full outcome will not come out before 2017. Until then we need to be careful about what it has proven, and, as Jen Lundgren pointed out, it will never be possible to show with mathematical certainty that the risk of transmission of someone in successful HIV therapy is absolutely zero. In addition, these results exclude situations where ART failed in the HIV-positive partner, although there were few of these cases.
Tradução: Rodrigo Sgobbi Pellegrini
A personal note: CTRL + C CTRL + V
These results exclude where ART failed!
* The simple possibility, with all that has been said, written, published everywhere, even now, after years, I would feel impeded, both from the ethical and moral point of view of relating to someone without a condom only because I have been undetectable for more than ten years, since "TARV could fail!"
I still remember how I felt with the result, the terror, the fear, the unknown. The "old problem of others". If I close the acoustics of my Spirit to my own past, I cease to be who I am. It's surreal!
After the publication of this text there is more to be seen on this link and I advise you to read
The Rodger et al. HIV transmission risk through condomless fri IF HIV + partner on Supressive ART: PARTNER study. Conference on Retroviruses 21st and Opportunistic Infections, Boston, abstract 153LB, 2014.