Hiv Undetectable?

topic posted Wed, August 20, 2008 - 8:49 PM by  Unsubscribed
Ok.... so lately i've been reading and hearing of men who claim to be HIV undetectable...and thus they are unable to transfer the disease. Now.. This is a first. My gut/knee jerk reaction based on what I know thus so far is that even if the antibodies are low and your white blood cell count is great and high..... One still can transmit HIv into another host via blood/semen. Is there other information and studies that i need to be updated on.

Lately i've been seeing people online in profiles saying "i'm undetectable.... I BB".
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  • Unsu...

    Re: Hiv Undetectable?

    Thu, August 21, 2008 - 2:53 PM
    there's a lot of hoopla about this right now. a study recently showed that when the viral load is undetectable, HIV is not transmitted in the absence of other STDs and various confounding factors. it needs to be duplicated and the bottom line is that being undetectable isn't an excuse to stop using condoms....yet

    according to sf aids foundation:

    Is Someone Who Takes HIV Drugs able to Transmit HIV?

    Some people believe that taking antiretrovirals or having an "undetectable viral load" means that they can't transmit HIV to their sexual partners. That is nottrue. A person who takes HIV treatments--even those who have "undetectable" viral load counts--can still transmit HIV.

    Effective drugs, taken properly, can significantly decrease viral load (the amount of virus in one's blood). It is known that the higher one's viral load, the more likely one is to transmit the virus and the lower one's viral load, the less likely one is to transmit the virus. But, regardless, HIV can still be transmitted. It is also important to note that viral load can change from day to day, so one can never be certain of their viral load count at a particular time. In addition, viral load tests only reflect the amount of virus in the blood, not necessarily the level of virus in other bodily fluids, such as semen and vaginal fluid.


    Here's the citation to the article, I'm yet to find it in English:

    P Vernazza et al. Les personnes séropositives ne souffrant d'aucune autre MST et suivant un traitment antirétroviral efficace ne transmettent pas le VIH par voie sexuelle. Bulletin des médecins suisses 89 (5), 2008.

    the gist of it as that it is a promising sign, but there are various confounding factors and the study needs to be duplicated. i would stick with sfaf and various other organizations that say the same.

    One of my colleagues at the clinic I volunteer at had this to say:

    The swiss opinion piece is based largely on results from an observational study that, while very promising, also showed that stringent conditions are required for ART [anti-retroviral therapy] to be protective....monogamous stable relationships, consistently undetectable viral load, and absence of STIs. Along with ART, condom use was also protective.

    he also mentioned another study that may be reproducing these results, we'll see. interesting study tho...
  • Unsu...

    Re: Hiv Undetectable?

    Tue, September 30, 2008 - 2:18 AM
    man this shit sounds dangerous!

    Viral loads can fluxuate/change rapidly and just because somene is on tons of HIV meds it doesn't mean that other Poz/Neg person they are with won't become HIV+ or get another strain of HIV or pass another strain of HIV to the other HIV+ person if they are Poz.

    If you want to go and have sex with people who are HIV+ nobody is stopping you but when you wind up HIV+ you'll only have yourself to blame.

    People who are HIV neg and knowingly have sex with HIV poz people are into risky sex, playing with fire, and they've got a death wish and are probably bug chasers even if they do repress it or don't even realize it themselves, or want to admit it.

    I know it's not PC to say this but it's true and HIV does equal a slow horrible death no matter how many toxic medications you take that harm your body (the meds while they might be good for combating HIV and keeping the TCell count from lowering are VERY bad to take), and the best way not to get HIV is not to have sex with Poz people or share needles if you IV drugs.

    When are the HIV poz people going to realize that the only way to rid our planet of this scourge is for them, as a group, to take the matter into their own hands and refuse to engage in sexual activity with anyone who is not HIV poz, ever, for any reason?

    Why cannot HIV+ people not recognize the power they have to make a great contribution to humanity by declaring that they will not, under any circumstance, engage in any behavior that carries with it the possibility of HIV transmission to another human being?

    Why is it that Poz people do not feel incredible remorse when engaging in behavior that carries this risk? Why is it that they are willing to serve only their desires and are willing to engage in sexual activity with anyone who does not question whether the risk of HIV transmission is present? Also let's not forget about how many people who are HIV+ also have Hepatitis C and how easily that can be transmitted to others.

    This troubles me greatly. I used to feel nothing but compassion for those with HIV, but the longer that I am exposed to their reckless behavior, the less I am able to hold compassion in my heart.

    I even know people who are HIV+ who don't tell others that they are when they have sex with them, even when they're asked by the other person/people, or when the other person/people want to swallow them or bareback them.

    I know Poz people who still bareback/swallow and don't care how many strains of HIV they get or pass onto others, and I even know HIV+ people who are involved in HIV educational centers and non profit orgs where they tell people how important it is to get tested and use condoms, yet they are all into bug chasing/breeding/"gift" giving and are totally cool with letting people gang fuck their ass every weekend and flood it with load after load.

    You can get HIV from giving oral sex, and swallowing or having semen in your mouth is high risk for HIV; but it's not as risky as unprotected receptive anal sex or sharing a rig/works (needles) with an HIV+ person.

    Also just because someone is on medications it doesn't mean that your chances for gettting HIV are completely eliminated or that you can't get it from giving oral sex without or with swallowing, since viral loads can go up unexpectedly when someone is on meds.

    Yes PEP (the post exposure meds) are available but the side effects suck and you have to take them for months and it's no gaurentee that you won't become HIV+.
    • Unsu...

      Re: Hiv Undetectable?

      Tue, September 30, 2008 - 4:09 PM
      man this shit sounds dangerous is exactly right....let me tell you what sounds dangerous...

      I feel this response is filled with sweeping generalizations and wrong information. It puts people into boxes, robs them of their agency and aims to ostracize them from the rest of society. Viral loads don’t fluctuate – the basis of the study is the fact that once you get to an undetectable viral load, it is not transmissible. Granted, there are stringent conditions that must be met and the study is preliminary. However, you cannot completely discount it, as you have decided to do.

      I am also in complete disagreement with your statement that people who knowingly have sex with people with HIV “are into risky sex, playing with fire, and they've got a death wish.” It’s inappropriate to say something so strong and presumptive. There are many reasons people engage in the sexual activity they do.

      Then you go on to say that HIV leads to a miserable death and discount the benefit of the drugs. Of course they make you feel like shit – they also help to keep you alive for a lot longer. Adding to this that they need to “refuse to engage in sexual activity with anyone who” isn’t infected is ridiculous. That simply isn’t the way the world works. I feel this isolates the HIV positive community even more than they already feel. I cannot speak for the entire HIV positive community, but there is something fundamentally wrong with demanding they don’t have sex. Or shall we go back to the eugenics arguments from the beginning of the 1900s…

      I find your methods for prevention very interesting, as well. You tell us the best method of prevention is not to have sex with positive people or share needles. What if having unprotected sex is the only way you're going to get dinner or a place to stay tonight? What if you have an addiction and getting high now is more important than your health in ten years? I don’t have vast experience working with sex workers and injection drug users, but I have worked with a few as well as talked to many that DO work in those fields and experience (and, likely, research) will tell you that you’re a little off.

      As for telling the HIV community not to have sex, do you realize that as much as a quarter of the HIV-infected population doesn’t know they are infected? Sorry, even if they took your advice, the epidemic wouldn’t stop. Then you mention hepatitis C – surely you know that it isn’t transmitted easily through sex to the point that the medical community doesn’t call it an STD, right?

      Then you lose your compassion for the HIV positive community. How dare you decide that the experiences of a few people YOU know personally reflect those of a worldwide community of literally millions of HIV positive individuals? Instead of judging them, perhaps you could offer them support they need. I feel it is exactly people that make statements like yours that marginalize communities and lead members of them to engage in irresponsible behavior.

      It also appears that you’re convinced HIV is transmitted by oral sex. This is extremely contested in the medical community. In the absence of sores or lesions, your risk is relatively low. Continuing with your medically wrong information, you end with what you started on – that major researchers are wrong and “viral loads can go up unexpectedly when someone is on meds.” You also say PEP is taken for months – when its not, only one month – and that there’s no guarantee. Of course there isn’t a guarantee, just like in your ideal world where the HIV positive population somehow isolates itself, despite so many people being infected and not knowing, there’s still no guarantee. It’s the treatment the medical community has accepted, and, like other things in life, no, there’s no guarantee. Unless you want to complete all the research to disprove what’s already out there, I suggest you check your facts before making claims as you have. I also strongly urge you not to judge, criticize, marginalize, or demean any community in an open forum such as this.
    • Re: Hiv Undetectable?

      Tue, July 6, 2010 - 6:15 PM
      I just had to respond to this post because of the large amounts of misinformation that is being claimed as fact; and because of the obvious internalized fear you are projecting into irrational and discriminatory suggestions in the name of ending HIV. As a point of disclosure, I am an HIV/AIDS researcher for the Department of Public Health with a master's degree in the subject, and follow (and contribute to) the research extensively. I felt it my minor duty to clear up some of the information for anyone else who reads this thread in the future.

      The Swiss Study is the first, admittedly bold, but entirely scientifically informed, proclamation that HIV-positive people are non-infectious given that they are a) on successfull ARV treatment that has reduced their viral load to undetectable levels for at least six months, b) do not have any other STIs, and c) have continued access to health care that monitors the above. The study DOES NOT outright say that HIV-positive folks should discontinue use of condoms, although this conjecture is well within the logical slope that they present, and it is this potential conjecture that has been the largest cause of concern within the HIV/AIDS research community. Importantly, the study was a meta-analysis meaning they did not gather any new information but rather amalgamated information from already completed studies. The resulting statement was a result of analysis and discussion and was primarily meant for the medical and research community.

      Their argument is buttressed by the latest study from 2010 CROI (Conference on Retroviruses and Opportunistic Infections) which concludes that the risk level for serodiscordant couples where the HIV-positive person is on treatment (regardless of their viral load and safer sex behaviors) is 0.08% Yes, that's LESS THAN 1%. If you include the consideration of undetectable viral load, it is completely within the realm of scientific possibility that HIV-positive folks falling under the above guidelines are essentially non-infectious. It was not an erroneous or scientifically unsound conclusion - just one that could have disastrous public health implications. Understandeably, the hoopla denouncing the statement has attacked just that - the public health implications - not, the science.

      Also important was that the studies they analyzed were largely of heterosexual serodiscordant couples, and the applicability of the results is still questionable given the different transmission methods of MSM. But the biological basis of their argument remains the same - undetectable viral load in the blood means undetectable viral load in the semen 95% of the time. The remaining 5% of the time the viral load in the semen is at a level that does not stastically signal infectiousness - this is because the lowest recorded case of viral load infectiousness between a serodiscordant couple was at 1000 u/l (meaning every recorded case of infection between a serodiscordant couple was when the positive partner had a viral load higher than 1000).

      So that brings up your first point of viral load "blips" between tests. A study that addressed this very question found that there is a 95% chance that the viral load will remain under the 1000 u/l marker between undetectable viral load tests (generally given every 3 months), and that number goes up to 99% if the HIV-positive person was initially treated with at least a three-drug cocktail (versus two or one). Again, not 100%. But your chances of being infected by just about every other STD is greater than it is of getting HIV from a known HIV-positive person who fits the above profile.

      I know the other gentleman responding to your post addressed this already, but I just have to reiterate that HIV DOES NOT "equal a slow horrible death" NECESSARILY. In fact most studies show that many of the HIV-positive people living today will in fact die of a NON-HIV related disease. The difference between mortality rates (people who die from HIV-related deaths) versus the morbidity rates (people who are suffering from HIV-related illness) is increasing year after year. This means that people who are HIV-positive are still dying, but more and more it is because of non-HIV related illnesses. They die of heart attacks, strokes, and cancer just like the rest of the world.

      Relatedly, the medications today and many in the pipeline are very well-tolerated. The side-effects of 10 years ago (lipodystrophy, peripheral neuropathy, wasting) are being seen less and less. That's not to say they aren't happening, because they definitely are, but physicians now have an army of alternate medications that they can choose from to help mitigate the side-effects.

      I'll leave the social stigma issues you brought up alone because they were addressed by two previous posters. I'll just say that I sincerely hope that you are able to reconsider your views based on real scientific information, rather than the fear and dated information you base your current viewpoints on. Also, many many many studies actually show a marked DECREASE in risky behavior by HIV-positive folks once they learn of their diagnosis, not the anecdotal increase you seem to be arguing for. Indeed, there are people like you described who continue to put others at risk - but that is not by any means the general behavior of the HIV-infected.

      Lastly, oral sex is not a "high risk" activity like you stated - in fact, even for someone who is not on medications it is considered a "low risk" activity. The risk is not zero - but there are actually no verified cases of transmission occurring this way - again, just anecdotal evidence which may or may not be the result of self-reporting variances (i.e. they simply don't report having had risky anal sex because of the self-blame, etc. that it would induce). Admittedly, this would be an impossible and unethical clinical trial to conduct, so we may never know 100%. Speaking in abstract, it is definitely possible - absolutely, all signs point to probably. Speaking scientifically, we simply don't know for sure.

      Please please please inform and educate yourselves before putting information out there that further stigmatizes and divides an already disparate LGBTQ community. If we are ever going to overcome this disease, we are going to have to do it together.
      • Re: Hiv Undetectable?

        Thu, February 2, 2012 - 4:30 AM
        Does anyone know if there are any reported cases of HIV being transmited from someone that is on medication and has an in detectable viral load??? Thanks
        • Unsu...

          Re: Hiv Undetectable?

          Thu, February 2, 2012 - 11:11 AM
          Yes you can get infected with HIV even if the other person is on medications and "undetectable".

          Even if you are HIV+ and on meds and undetectable you can still get reinfected with other strains of HIV, or infect someone else that's HIV+ with another strain of HIV.

          You can also get other STDs as well. Ignore the idiots with death wishes who claim that if you're HIV+ and on meds that you can't infect and HIV Neg person or that you can do it raw and bare all you want and not get infected with other strains of HIV or get reinfected.
  • Unsu...

    Re: Hiv Undetectable?

    Tue, April 14, 2009 - 10:55 PM
    I agree with the person who wrote how it sounds dangerous.

    The real reasons why the notorious Swiss study was so roundly condemned. It's not because it went against the "condom always" advice, which is egregiously disingenuous on his part.

    This study is easily misinterpreted, for one thing, because all its subjects were heterosexual and engaged only in vaginal intercourse. Compared to unprotected vaginal intercourse, unprotected anal intercourse is 10 to 100 times more likely to transmit HIV. The lining of the rectum is far more fragile than that of the vagina, and the cells that are open to infection are much closer to the surface. During anal intercourse this lining may rupture, allowing HIV to break through and infect cells.

    Furthermore, it is simply not true that "undetectable" = "noninfectious." HIV is found to be "undetectable" ONLY in the circulating peripheral blood, but only 2% of CD4 cells in the body, the cells infected by HIV, are found in the peripheral blood. The other 98% of CD4 cells are found elsewhere, and the viral-load test is not testing "elsewhere." HIV is present in the gut, the lymph nodes, the brain, the testes.

    Did the Swiss scientists look for HIV in semen? Did they prove that HAART made HIV undetectable in all these other places in which HIV "hides" or lies dormant?

    If a viral-load test is undetectable in the peripheral blood, and HIV is therefore, according to the Swiss, incapable of being transmitted, why haven't they also declared that such "undetectables" are cured?

    From the Associated Press:

    "Not only is [the Swiss proposal] dangerous, it's misleading and it is not considering the implications of the biological facts involved with HIV transmission," said Jay Levy, director of the Laboratory for Tumor and AIDS Virus Research at the University of California in San Francisco. Levy said there was no safe way of knowing whether a patient with HIV who has no detectable virus in the blood will not transmit the virus. More research into the links between viral load in the blood and the presence of the virus in genital fluid was needed, he said.

    Men who are treated with anti-HIV therapy can develop drug-resistant virus in their semen, and there is evidence of multi-drug resistant strains of HIV developing in the genital tract but not blood. Furthermore, semen that has an undetectable viral load is still potentially infectious, and cells in semen can contain HIV proviral DNA and can act as vehicles for sexual transmission of HIV.

    THAT is why responsible prevention advocates recommend that HIV prevention messages targeted to both infected and uninfected persons communicate the importance of condoms and other risk-reduction strategies regardless of HIV treatment status and at all stages of HIV disease.

    Thu, June 17, 2010 - 10:46 PM
    One of these guys sounded like he was reading from Mein Kampf. To add a little more grounded common sense to this discussion:

    If you are having sex with someone who is HIV+, it can be totally safe. Just take certain precautions:

    1. Use two condoms when having anal sex.
    Crown skinless skin condoms, manufactured by Okamoto in Japan are a great brand that almost never break (i.e. never) and feel great on. And in the RARE chance it does break you can count on the second one you have on!
    2. Ask your HIV+ partner to pull out before cumming (if it makes you feel better)
    While any precum will be trapped inside the condom, you have the added security that their mother load is outside of your concerned ass.
    3. Wear a single good quality condom when performing or receiving oral sex
    (none of the existing posts suggest this--HELLO!) As you have your mouth on it, you can ensure it is secure and unbroken. A super thin japanese condom works well for this (it's what many pornstars use)
    4. Before kissing your HIV+ lover make sure both your mouths are safe and sealed up.
    Ensure that neither of you have brushed your teeth, flossed, or eaten foods that might have irritated the gums for at least four to five hours prior to contact. Also remember that HIV is not carried in saliva and even if there was an undetectable abrasion in one mouth, the likelihood of you contracting HIV from a HIV+ person on meds is next to NON EXISTENT (BOTH of you would have to have open wounds in your mouth that made blood contact and defied an undetectable viral load--if you're even the least bit careful, it ain't gonna happen--and I don't think there is ANY record of this ever occuring).
    5. Finally, enjoy foreplay.
    Obviously make sure there are no open wounds on the body (and don't do things like pop or disturb a pimple as there could be blood). Body licking, massage, fingering (use a glove if you feel safer), necking, etc. Great risk free foreplay combined with safe sex will make for a fantastic and SAFE experience with your HIV+ lover--short or long term.

    It is also worth noting that many new HAART therapies have little to NO side effects and while still demanding of the liver and kidneys, newer far less toxic therapies are already coming out and are definitely on the horizon. Many recent international studies show that the mortality rate of HIV+ and HIV- people is getting closer and closer to being equal (provided that HIV+ people catch the desease early and start and MAINTAIN therapy and a healthy lifestyle). A recent study in France showed that HIV+ people with a healthy lifestyle who are diligent about taking their meds can expect to live as long as someone who is HIV- (see the article here Of course quality of life is still the big question, but if you are able to stay healthy and happy, with newer therapies on the horizon, the prospects of a healthful long life are already very very good and are just getting better for people with access to good healthcare.

    So if you develop a long term relationship with someone who is HIV+ don't expect that you'll be taking care of someone who is always sick when they get older--the likelihood is they won't be (if they maintain a healthy lifestyle and stick to their meds).

    To say that HIV+ people should not have sex with HIV- people is built on fear. You might as well be asking black people to go to the back of the bus. If they and their partners are RESPONSIBLE (extra safe oral and anal sex, safe kissing practices) and they are on meds, the risk is next to none. There are MANY responsible HIV+/HIV- long term couples out there--in their 50s and older!

    And consider (as one writer mentioned) that MANY people out there are HIV+ and don't know it! If you are having safe sex with someone who is HIV+, you are probably WAY less at risk then if you have unprotected sex with someone who swears they are HIV- so suck on that.

    Just use common sense. Be logical and considerate. A sexual relationship with someone who is HIV+ can be very safe.

    Happy fucking.
    • Re: HIV+ SEX IS SAFE

      Fri, July 9, 2010 - 1:10 AM
      "That simply isn’t the way the world works."

      That's not the way WHOSE world works?

      It is mind-boggling to me that anyone could still be out there day after day having casual and anonymous sex with multiple partners knowing the prevalence of the HIV rates and the risks involved. It's why I stay home alone all the time. I have never had any interest in sexual activity without an emotional and intellectual relationship being involved, and given the disease factor, you could not pay me enough money to have sex with anyone that I was not in a monogamous relationship with. Which is why I am single. I completely reject that current gay paradigm that we are to stay single, or become partnered, and just keep fucking whoever comes down the street. Instead, I want the expansion of consciousness that comes when two people are involved in a loving partnership on all levels. I don't ever want to have to worry about STD's at all ever again as long as I live. And no sexual encounter is worth my peace of mind. NOBODY can do me like I can anyway.

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