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Treatment and Prevention

HIV treatment significantly reduces transmission – the science is in!

The Swiss Statement – In 2008 the Swiss Federal Commission for HIV released a controversial statement saying that individuals with an undetectable viral load and no STI (sexually transmitted infection) cannot transmit HIV during sex. Four of Switzerland’s top HIV experts had reached a consensus, resulting in a public statement that sent the global HIV sector into a spin.

Their assertion that people with HIV on effective treatment (ART or Antiretroviral Therapy) posed a negligible risk to their sexual partners was based on ‘review of the medical literature and extensive discussion’ and was, they asserted, ‘much more informed’ than in 1986 when the statement ‘HIV cannot be transmitted by kissing’ was publicised.

Still, the outcry was immediate. While some HIV organisations cautiously welcomed the statement, others expressed concern that it only pertained to heterosexual sex and behaviour, (as if heterosexuals never engage in anal sex or other behaviours), and that it would prompt people with HIV to stop using condoms, risking STIs and possibly transmitting HIV if they didn’t monitor their treatment adherence.  It was also argued that, in between viral load tests, who knew whether the virus was really undetectable.

More than one organisation called for caution, while others released their statements, warnings and rebuttals.

HPTN052 Study – Then in 2011 a large randomised clinical trial over 5 years produced more solid evidence…HIV treatment significantly reduced infectiousness. In fact, in the group which received early treatment, only one transmission occurred – and that was before the HIV positive person’s viral load had gone undetectable. The study concluded ART is 96% effective in reducing transmission. It could be argued that figure would be higher if you add the criteria of the Swiss Statement – undetectable for 6 months, no STI present and regular viral load monitoring. The one transmission that occurred in the group taking ART was from a person who had not been on treatment long enough to achieve an undetectable viral load.

HPTN052 proved the Swiss Statement was correct. Something many already believed. After all, would the top HIV medical experts in Switzerland release a statement like that if they weren’t really and truly convinced?

And now we have what is already being called the UK Statement.

In January 2013 the British HIV Association (BHIVA) and the Expert Advisory Group on AIDS (EAGA) released a position statement on the use of ART to reduce HIV transmission.

It states that, in serodiscordant couples (where one has HIV and the other does not) where the partner who is HIV positive is taking effective ART, the risk of transmission through vaginal intercourse is ‘extremely low’ provided the following conditions are fulfilled:

  • There are no sexually transmitted infections in either partner
  • The person with HIV has had a sustained plasma viral load below 50 copies/ml for more than six months, including the most recent test.
  • Viral load testing occurs every three to four months (i.e. more regularly than in standard clinical care).

It goes on to say that successful ART used by the HIV positive partner is as effective as consistent condom use in limiting HIV transmission.

The UK statement also says that in its expert opinion, the risk of transmission during unprotected anal intercourse is extremely low, provided the above conditions are met, although they acknowledge that receptive anal intercourse carries a higher risk in general.

This is good news for serodiscordant couples.

If you are HIV positive and considering having a relationship or being sexual again, get informed and stay in touch with your HIV doctor. Once you understand what to do to minimise risk, you can have sex without worrying…and that’s got to be good news!

Feel free to research the studies yourself, and let us know what you think…will it help you in your relationships? Does it give you and your partner peace of mind? How good are you at taking your meds? Leave your comments below…

 

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