Myth Versus Fact, Athough the facts about HIV are well know, there still remains speculation about HIV.

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    Dec 30, 2009 5:09 PM GMT
    What are some of the facts and myths about HIV? some examples include, Myth: HIV can be transmitted through everyday contact,Fact: there are no documented cases of HIV being transmitted through casual contact,hugging, handshaking, using the same bathroom or plates.
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    Dec 31, 2009 12:24 AM GMT
    how about the myth among poz that being undetectable means you can't transmit HIV/AIDS.
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    Dec 31, 2009 1:02 AM GMT
    ASGCville saidWhat are some of the facts and myths about HIV? some examples include, Myth: HIV can be transmitted through everyday contact,Fact: there are no documented cases of HIV being transmitted through casual contact,hugging, handshaking, using the same bathroom or plates.


    That's not a myth. That's pure ignorance. A myth usually involves some sort of weight on an opposing side with a bit of empirical evidence to back their claims (i.e., the myth that HIV doesn't even exist- see many other discussions on RJ for this one parsed out).
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    Dec 31, 2009 1:12 AM GMT
    actually Yogi, you're right. myth requires a historical context. so we're really dealing with false beliefs.
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    Jan 04, 2010 5:48 PM GMT
    I agree also, it is pure ignorance, my example believe it was from an online resource, I should have stopped to think before posting, however I’m glad you made the point. I got something out of it.
    Thanks
  • cobra2814

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    Feb 21, 2010 7:06 AM GMT
    Bowie saidhow about the myth among poz that being undetectable means you can't transmit HIV/AIDS.


    Myth? Please cite your source that shows a recorded occurance of an HIV+ individual transmitting the virus while having a viral load that is undetectable (less than 50 copies per mL of blood).

    I've talked with several HIV specialists who've been MDs in the field for over 20 years about this very issue, and none of them have seen or even heard of one case of this happening.
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    Feb 21, 2010 7:20 AM GMT
    cobra2814 said
    Bowie saidhow about the myth among poz that being undetectable means you can't transmit HIV/AIDS.


    Myth? Please cite your source that shows a recorded occurance of an HIV+ individual transmitting the virus while having a viral load that is undetectable (less than 50 copies per mL of blood).

    I've talked with several HIV specialists who've been MDs in the field for over 20 years about this very issue, and none of them have seen or even heard of one case of this happening.


    the medical community generally accepts that it is more difficult to transmit HIV when the viral load is 'undetectable', however, no one can prove this theory.

    it IS clear that HIV is detectable in the rectal mucosa/fluids even in individuals with undetectable viral loads in other body fluids (blood, saliva, urine, tears, etc.)

    citation from one of many studies confirming this fact:
    http://www3.interscience.wiley.com/journal/86011387/abstract
  • cobra2814

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    Feb 21, 2010 7:38 AM GMT
    I appreciate that study, however it was done in 2001, and here we are in 2010 without one recorded incident of viral transmission from an individual with an undetectable viral load.

    There are many reservoirs of the virus within the human body, and the lymph system is the biggest one (being largely located within the intestinal tract). Meds don't reach these areas, which is why they don't cure, but rather control the infection.

    My point is that it is well known that viral load and level of infectiousness are highly correlated. A viral concentration that is too small to be detected on highly sensitive tests, reduces the infectiousness of that person to the point where it simply has not been observed, period.

    I'm sure you are aware of the Swiss study done in 2007. While it's difficult to draw a direct line between hetrosexual and homosexual sexual activity, the strength of the evidence is clearly in favor of an undetectable individual NOT being capable of transmitting the virus.

    For a certain poster to call this a "myth" is just ignorant, and his statement demands correction.
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    Feb 21, 2010 7:44 AM GMT
    cobra2814 saidI appreciate that study, however it was done in 2001, and here we are in 2010 without one recorded incident of viral transmission from an individual with an undetectable viral load.

    There are many reservoirs of the virus within the human body, and the lymph system is the biggest one (being largely located within the intestinal tract). Meds don't reach these areas, which is why they don't cure, but rather control the infection.

    My point is that it is well known that viral load and level of infectiousness are highly correlated. A viral concentration that is too small to be detected on highly sensitive tests, reduces the infectiousness of that person to the point where it simply has not been observed, period.

    I'm sure you are aware of the Swiss study done in 2007. While it's difficult to draw a direct line between hetrosexual and homosexual sexual activity, the strength of the evidence is clearly in favor of an undetectable individual NOT being capable of transmitting the virus.

    For a certain poster to call this a "myth" is just ignorant, and his statement demands correction.


    i'm aware of the Swiss study and many others... it's what i do. i treat HIV infection in over 1800 patients. we also perform clinical trials. i make no judgments about your opinion... but it is nothing more than opinion. the fact remains that HIV can be spread by an individual who is 'undetectable'... i see it all the time. i've treated quite a few individuals in serodiscordant relationships whose only risk factor was unprotected sex (without ejaculation) with their 'undetectable' partner. saying it doesn't happen doesn't make it so.

    there are dozens more studies with similar findings to the one i posted. btw, reality doesn't change because findings are 9 years old.
  • cobra2814

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    Feb 21, 2010 7:56 AM GMT
    I didn't realize you were an HIV specialist, so I do value your opinion.

    You say that you have treated serodiscordant couples where the positive individual was undetectable and transmission occured? If this is the case, it would be nice to share that information with many of the other HIV specialists out there who refute what you have observed.

    Additionally, are you sure they were undetectable at the time of transmission?
    How compliant are they with their medication? At the time of transmission, were there any other STDs present in either individual? Had the undetectable individual been undetectable, consistently, for longer than 6 months?

    All of these are other issues that need to be controlled for before conclusively stating that an individual with an undetectable viral load can spread the disease.
  • cobra2814

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    Feb 21, 2010 8:08 AM GMT
    rightasrain, this link is for everyone else who may be reading this thread, as you have already said you are aware of the study.

    For everyone else: http://www.aidsmap.com/en/news/4E9D555B-18FB-4D56-B912-2C28AFCCD36B.asp

    I summarize below:

    Swiss HIV experts have produced the first-ever consensus statement to say that HIV-positive individuals on effective antiretroviral therapy and without sexually transmitted infections (STIs) are sexually non-infectious.

    It goes on to say that this statement is valid as long as:

    * the person adheres to antiretroviral therapy, the effects of which must be evaluated regularly by the treating physician, and


    * the viral load has been suppressed (< 40 copies/ml) for at least six months, and


    * there are no other sexually transmitted infections.
  • cobra2814

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    Feb 21, 2010 8:18 AM GMT
    And to put a finer point on it, http://i-base.info/htb/152

    This study was published in October 2008, so recent data.

    Summary:

    An Australian research group, led by David Wilson from the University of New South Wales, Sydney, published a study in the Lancet modelling the potential impact of a low-level residual transmission risk.

    The model looked at the risk of unprotected sexual transmission per act and cumulatively over many exposures, within couples where one partner is HIV-positive and the other is HIV-negative.

    They assumed that each couple had 100 sexual encounters per year, and calculated a cumulative probability of transmission to the HIV-negative partner each year.

    This modelling suggested per exposure risk rates from an HIV-positive partner on ARV treatment, fulfilling the above criteria,from 1 in 43,000 for anal sex to less than 1 in 220,000 for vaginal sex.

    So there you have it. The best and most recent data science can produce gives a 1 and 43,000 chance of HIV transmission from an undetectable positive partner to a negative one. Pretty much not gonna happen.



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    Feb 21, 2010 4:46 PM GMT
    cobra2814 saidI didn't realize you were an HIV specialist, so I do value your opinion.

    You say that you have treated serodiscordant couples where the positive individual was undetectable and transmission occured? If this is the case, it would be nice to share that information with many of the other HIV specialists out there who refute what you have observed.

    Additionally, are you sure they were undetectable at the time of transmission?
    How compliant are they with their medication? At the time of transmission, were there any other STDs present in either individual? Had the undetectable individual been undetectable, consistently, for longer than 6 months?

    All of these are other issues that need to be controlled for before conclusively stating that an individual with an undetectable viral load can spread the disease.


    in the cases i cite, all variables you mention above were controlled for. controlling for layer after layer of variable to reach a conclusion is important in research but you have to read between the lines... people don't live in controlled environments... they live in the real world.

    HIV is a relatively difficult virus to transmit, but it continues to occur and it occurs from undetectable individuals to HIV-negative individuals. my business partner will tell you it rarely happens in the latter case.... OK, so it rarely happens. it still happens. any HIV specialist with a sane head on his shoulders should tell you it happens... if they tell you irrefutable evidence exists to the contrary, they should have their license yanked.

    regarding the 1 in 43,000 nonsense... there are lies, damned lies and statistics.. those results were extrapolated from sexual encounters with the same partner. and '1 in 43,000' (if you believe the numbers) is not 'pretty much not gonna happen'... it's a measurable risk. if people stayed in their homes they wouldn't get hit by a bus crossing the street. tell the statistics to the 1 person in 43,000 that gets infected. perhaps that person is you... which is why you seem so heavily invested in claiming that being undetectable is synonymous with 'noninfectious'? and btw, 'recent' data isn't more accurate/valid data... it's just more recent. you seem stuck on the principle.
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    Feb 21, 2010 5:30 PM GMT
    I'm going to chime in here because I think this is an issue that should be quashed and fast.

    cobra, if you're going to cite a study, then cite the PRIMARY source, not the secondary one. It looks like you're regurgitating the opinion of someone else who read the Lancet study and not like you actually read the Lancet study itself, because if you had actually READ the Lancet study, then you would have realized that the mathematical modelling done to project the risk of HIV transmission from "low-viral-load" individuals to serodiscordant individuals was based on data on HETEROSEXUAL couples.The model also assumes that the 100 sexual contacts per year are within the same couple--not mulitple partners. So from an inferential point of view, your conclusions violate one of the basic principles--a study can only be generalized to the populations that it studies.

    The authors of the study itself also state that they, ...believe that the Swiss statement is not a sensible public-health message..." on a number of grounds, which are more lengthy than I care to cut and paste in this reply.

    The purpose of the study was to point out that under mathematical rules that assume perfect human behaviour and near-perfect viral control in a heterosexual dyad, that the risk of HIV transmission is not zero. 1 in 43 000, while to you, seems pretty rare, is not, in fact, that rare at all, given that the denominator of that "odds" is for "sexual encounters" not "partners", or "relationships"

    So before you're going to go up against a team of medical physicians and researchers using arguments with secondary data, I suggest you at least go into the primary data first.

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    Feb 21, 2010 5:34 PM GMT
    fact: use a condom
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    Feb 21, 2010 7:47 PM GMT
    [quote][cite]bryanc_74 said[/cite]I'm going to chime in here because I think this is an issue that should be quashed and fast.

    Very poor choice of words. Healthy scientific debate should never be quashed. There are thousands of studies and trials on HIV and AIDS much of which gets very little play or viewed.

    Even the concepts you believe as fact should always be questioned especially if they don't quite fit reality or answer events that exist. If you have had any science, I did read you profile by the way, you would know through out our human history it has been men that continually challenge the prevailing theories. If not for them we would be reading in school about the earth being the center of the universe and still continuing to put billions of dollars in viral causes of cancer as we did for 30 years.

    You said " So before you're going to go up against a team of medical physicians and researchers using arguments with secondary data, I suggest you at least go into the primary data first."

    I applaud Cobra although I don't know him he seems more than capable of entering in a scientific debate with medical physicians and researchers. This is a very poor place to have a scientific debate on this subject. I am sure like Cobra you can list other studies that seem to back up your conclusions about HIV which can be done without disparaging comments to his intellectually capabilities.

  • Mikeylikesit

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    Feb 21, 2010 8:17 PM GMT
    I dunnno....All I know is that my ex was poz & undetectable....We fuked like rabbits....Even hius HIV specialist said he would have sex with him if they where together....LOL
    icon_lol.gificon_eek.gif
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    Feb 22, 2010 12:08 AM GMT
    Roccoe said[quote][cite]bryanc_74 said[/cite]I'm going to chime in here because I think this is an issue that should be quashed and fast.

    Very poor choice of words. Healthy scientific debate should never be quashed. There are thousands of studies and trials on HIV and AIDS much of which gets very little play or viewed.

    Even the concepts you believe as fact should always be questioned especially if they don't quite fit reality or answer events that exist. If you have had any science, I did read you profile by the way, you would know through out our human history it has been men that continually challenge the prevailing theories. If not for them we would be reading in school about the earth being the center of the universe and still continuing to put billions of dollars in viral causes of cancer as we did for 30 years.

    You said " So before you're going to go up against a team of medical physicians and researchers using arguments with secondary data, I suggest you at least go into the primary data first."

    I applaud Cobra although I don't know him he seems more than capable of entering in a scientific debate with medical physicians and researchers. This is a very poor place to have a scientific debate on this subject. I am sure like Cobra you can list other studies that seem to back up your conclusions about HIV which can be done without disparaging comments to his intellectually capabilities.



    I completely agree. If it had been scientific or healthy, I would have approached it differently.
  • cobra2814

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    Feb 23, 2010 3:54 AM GMT
    bryanc_74 saidI'm going to chime in here because I think this is an issue that should be quashed and fast.

    So before you're going to go up against a team of medical physicians and researchers using arguments with secondary data, I suggest you at least go into the primary data first.



    I'm going to resist the STRONG urge to personally attack you as you seem fond of doing to me, and take the high road here. I summarized the studies for ease of reading for the casual observers of this thread. I read the whole study, the primary sources, and am fully aware of the study's protocol. I'm also fully aware of the difficulty in extrapolating hetrosexual sexual encounters to homosexual ones (if you read my earlier posts, you'd read that I typed exactly that).

    It was not my intention to go up against a legion of Real Jock "medical professionals" regarding this. I'm citing sources that back what MANY HIV specialists have told me regarding this specific issue. If any of you have specific evidence, not anecdotal, to the contrary, then I suggest you make it publicly known to your peers. Because most of them disagree with your observations.
  • cobra2814

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    Feb 23, 2010 4:02 AM GMT
    Getting tired of quoting, but this is directed at rightasrain:

    If all the variables I presented above were controlled for then you have a professional duty to inform your peers of such transmission, as I've spoken at length with many of them and their findings (many of whom have been in practice longer than you and with more patients) are in direct contradiction to what you claim. Perhaps if you stay silent on this, you should have your license yanked like those you chastised earlier?

    Regarding the numbers.....statistical evidence is what measures risk here and should not be disregarded by you and a tired old phrase casually comparing mathematical data to a lie. Sure 1 in 43,000 is measurable but negligible. You'd have to fuck 3 guys a day for almost 40 years to statistically be infected by someone with an undetectable viral load. Better get to work, stud.

    Regarding, me getting stuck on the principle, that is incorrect. The reason I cite recent data is that science is ever evolving and new data comes out that often times refutes old data. I try to show you the most recently available studies so that you can work with the best information. Perhaps HIV+ men should all just take AZT monotherapy like it's 1990 since "recent data isn't more accurate/valid" right?

    And finally, for you to attempt to draw some sort of connection between my arguments and HIV status is irresponsible, immature, and rude. My HIV status is none of your business (nor is yours, mine). If you must know the motivation behind my posts, it's because I do have many friends who have HIV and I'm sick of seeing the stigma and ignorant fear they face every day from other gay men. It's disgusting and I don't stand for it. People need to realize that HIV+ men are not something to be feared, and the risk of getting infected is not something to be feared when an individual is undetectable. Understand also that nowhere have I ever said condoms shouldn't be used.

    You're 50 years old, man. Grow up a bit.
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    Feb 23, 2010 4:05 AM GMT
    cobra2814 said
    bryanc_74 saidI'm going to chime in here because I think this is an issue that should be quashed and fast.

    So before you're going to go up against a team of medical physicians and researchers using arguments with secondary data, I suggest you at least go into the primary data first.



    I'm going to resist the STRONG urge to personally attack you as you seem fond of doing to me, and take the high road here. I summarized the studies for ease of reading for the casual observers of this thread. I read the whole study, the primary sources, and am fully aware of the study's protocol. I'm also fully aware of the difficulty in extrapolating hetrosexual sexual encounters to homosexual ones (if you read my earlier posts, you'd read that I typed exactly that).

    It was not my intention to go up against a legion of Real Jock "medical professionals" regarding this. I'm citing sources that back what MANY HIV specialists have told me regarding this specific issue. If any of you have specific evidence, not anecdotal, to the contrary, then I suggest you make it publicly known to your peers. Because most of them disagree with your observations.



    VIRAL LOAD AND HIV TRANSMISSION RISK

    A January 2008 statement by the Swiss Federal AIDS Commission sparked considerable controversy, suggesting that HIV positive individuals on antiretroviral therapy who are fully adherent, maintain an undetectable viral load (below 40 copies/mL) for at least six months, and have no concurrent sexually transmitted infections are "not sexually infectious" (at least via heterosexual vaginal intercourse).

    At the Mexico City conference, commission president Pietro Vernazza maintained that under the specific circumstances described, unprotected sex with a person with undetectable viral load carried a risk similar to that of sex using a condom: not 100% safe, but within a "comfortable range." But the risk is not non-existent, given that people on effective therapy may experience occasional transient viral load increases, or "blips," and that HIV may be present in genital and anal secretions even if it is undetectable in the blood.

    As described in the July 26, 2008, issue of The Lancet, Australian researchers used a mathematical model to quantify the small transmission risk under the circumstances described in the Swiss statement. Assuming that each couple engaged in 100 sexual acts per year, they calculated the cumulative annual probability of transmission as .22% for female-to-male transmission, .43% for male-to-female transmission, and 4.3% for male-to-male transmission. In a population of 10,000 serodiscordant couples, this would translate to 215 expected instances of female-to-male transmission, 425 instance of male-to-female transmission, and 3,524 instances of male-to-male transmissionabout four times greater than the risk when using condoms.

    "Although we agree that effective antiretroviral treatment which leads to undetectable viral load is likely to have a substantial effect on reducing infectiousness," the researchers concluded, "our analyses suggest that it should not replace condoms."

    Along similar lines, researchers at the University of Bern set out to conduct a systematic review of medical literature to verify the Swiss statement (AIDS 2008 abstract THAC0505). Looking at more than 200 published articles and 100 abstracts, they found none that exactly mirrored the conditions described in the statement. In the one study that included treated patients with undetectable viral load, no cases of HIV transmission were reported. In four studies of untreated patients with HIV RNA below 400 copies/mL, only one transmission occurred (from an individual with a viral load of 362 copies/mL). No transmissions were identified from individuals with HIV RNA below 40 copies/mL.

    At the Retrovirus conference, Steven Reynolds from NIAID presented findings from an analysis of 205 serodiscordant heterosexual couples in Rakai, Uganda (CROI 2009 abstract 52a). Participants were eligible for free antiretroviral therapy if they had a CD4 count below 250 cells/mm3 or advanced immunocompromise according to WHO disease-stage criteria; 12 HIV positive men and eight women started treatment. During 396 person-years (PY) of follow-up prior to treatment initiation, 34 cases of HIV transmission occurred, for an incidence rate of 8.6 per 100 PY. No transmissions occurred during 25 PY of follow-up while the positive partner was on therapy.

    In a similar but larger study, Patrick Sullivan and colleagues followed 2,993 serodiscordant heterosexual couples in Kigali, Rwanda, and Lusaka, Zambia, from 2002 to 2008 (CROI 2009 abstract 52bLB). HIV positive partners started antiretroviral therapy when their CD4 count dropped below 200 CD4 cells/mm3 or they developed moderate or advanced disease (again according to WHO criteria). During a median 17 months of follow-up, 175 cases of HIV transmission occurred, 171 from untreated partners (3.4% per 100 PY) and four from treated partners (0.7% per 100 PY). Couples in which the HIV positive partner was on antiretroviral therapy were actually less likely to engage in high-risk sex, leading the researchers to conclude that the reduced risk was likely due to a combination of antiretroviral therapy and reduced risk behaviors.

    In additional to mathematical models and epidemiological studies, researchers have also measured HIV shedding in semen as a predictor of potential transmission. In a letter in the September 12, 2008, issue of AIDS, French researchers described a man with persistent HIV RNA shedding into his semen despite his blood viral load being fully suppressed on HAART. The man's initial antiretroviral regimen brought his blood viral load to undetectable within four months (indicating good adherence), but his semen viral load remained unchanged. After a year, he switched drugs to try to reduce HIV shedding in his semen. His blood viral load remained undetectable, but his semen viral load did not begin to decrease until six months later, and did not fall below 400 copies/mL until 11 months after the switchor 22 months after first starting HAART.

    In the August 20 issue of AIDS and at the Retrovirus Conference (CROI 2009 abstract 51) another French team reported data from an analysis of paired blood plasma and semen samples from 145 HIV positive men with negative female partners enrolled in an assisted reproduction program that used "sperm washing" to enable conception without putting the woman at risk. They found that 5% of the men had detectable virus in their semen despite being on antiretroviral therapy and having a blood viral load less than 40 copies/mL (conversely, 6% had detectable HIV in their blood but not in their semen). All of these men had some semen samples with undetectable HIV, indicating that levels fluctuated over time and a single test might miss potentially infectious virus.

    Similarly, Prameet Sheth reported on a study comparing 25 HIV positive Toronto men who were starting antiretroviral therapy and 13 who had been on suppressive therapy for at least four years (CROI 2009 abstract 50). In all of the newly treated men, plasma HIV RNA became persistently undetectable (below 50 copies/mL) by week 16. While 70% had undetectable semen viral load (below 300 copies/mL) by week 4, some still had detectable HIV RNA in their semen at 24 weeks. Even more (48%) had at least one detectable semen viral load test after starting therapy; 14% of the time HIV RNA was detectable in semen but not blood plasma. Among the men on long-term treatment, about one-third had detectable semen HIV RNA. This was more likely to occur in men with higher baseline semen viral load, but baseline plasma viral load, CD4 cell count, and herpes simplex virus status did not predict HIV shedding in semen.

    "Although effective HAART often eliminated HIV RNA from the..
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    Feb 23, 2010 4:07 AM GMT
    semen, isolated HIV semen shedding was common, even after extremely prolonged suppression of blood viral load," the investigators concluded. "Public health messages and policy must be tailored carefully to reflect this reality."

    Finally, a study looking at stable male-male couples in which the negative partner was recently infected, genetic testing of viral strains in both partners showed that infectious HIV may be free-floating in the seminal fluid, not just sequestered as cell-associated DNA in infected semen lymphocytes (CROI 2009 abstract 49LB).

    Taken together, these findings indicate that while antiretroviral treatment clearly lowers the risk of HIV transmission and may play a role in reducing the scope of the epidemic, it is not a guarantee against infection in individual cases.

    =============
    HIV in Semen Despite Undetectable in Blood: "residual risk of transmission is still possible during unprotected intercourse"

    Reported by Jules Levin
    CROI 2009 Montreal Feb 8-12

    Studies at CROI report finding HIV in semen despite undetectable HIV in blood. HIV in semen may be infectious, in one semen sample with the highest HIV levels they examined it and found it to be contagious. Study authors say there is a risk for transmission, even if small, and public health messages should consider these findings. I think the Swiss statements rankled a number of researchers so they felt they had to do these studies.

    Recently, the Swiss Federal Commission for HIV/AIDS stated that a seropositive individual, with no other sexually transmitted disease (STD), under ART, and with an undetectable HIV-1 plasma viral load for at least 6 months, does not sexually transmit HIV.

    The presenter from the first study said " effective HAART eliminated detectable semen RNA shedding in most participants suggesting that effective HAART will reduce transmission at a population level, but isolated semen HIV shedding was detected in a significant proportion (48%) of participant and is potentially infectious, was infectious in patient with higher semen load in this study, suggesting that effective HAART might not reliable prevent transmission at an individual level". During Q&A the reliability of the assay this research group used (bDNA, Bayer Diagnostics) was questioned saying the discordant results were higher than that seen in previous studies.

    2nd study: "these results show that 5% of patients had detectable HIV in seminal plasma although they had concomitantly undetectable HIV in blood while they were under effective HAART & with no other STDs" looked for in the clinic. Seminal plasma HIV viral load was between 255-1230 copies/ml. "Although the presence of HIV-RNA-1 does not mean necessarily infectious viruses, this result suggests that cell free virus can be still present in semen despite fully active ARV treatment. These results should be taken into account in public health messages. Indeed, while effective ART is likely to substantially reduce HIV transmission at a population level, residual HIV RNA shedding can occur, suggesting that even small, a residual risk of transmission is still possible during unprotected sexual intercourse.

    This study confirms HIV RNA shedding is intermittent in semen over time and that the rate of 5% should be considered as a low estimation of this phenomenon."

    The second study was from French clinics where they have managed serodiscordant couples where the male is infected & not the female to allow for pregnancies with assisted reproduction. The impression I have is that the data presented comes from "the seminal plasma fraction" of patients after sperm washing for pregnancy at their clinic. Sperm is 'washed" and frozen until virological testing has shown the absence of HIV RNA detection. They used the Cobas Taqman HIV-1 Roche Asay to quantify HIV-1 RNA in blood and in seminal plasma (limit of quantification of 40 copies/l in blood, 200 copies/ml in seminal plasma). 7 paired samples, 7 distinct patients, had detectable HIV in seminal plasma but was undetectable in blood. These patients were on stable HAART with undetectable HIV in blood plasma for at least 6 months & had no other STDs that are systemically screened in the program (syphilis, chlamydiae, ureaplasma, mycoplasma). 6 of 7 had an undetectable concordant result in blood & semen in at least one other time point during followup.

    Persistent HIV RNA Shedding in Semen despite Effective ART

    Prameet Sheth*1, C Kovacs1,2, K Kemal3, B Jones1, C Laporte4, M Loutfy1,5, H Burger3, B Weiser3, R Pilon6, R Kaul1,7, and the Toronto Mucosal HIV Res Group 1Univ of Toronto, Canada; 2Maple Leaf Med Clinic, Toronto, Canada; 3Wadsworth Ctr, NY State Dept of Publ Hlth, Albany, US; 4Univ of Ottawa, Ottawa Hosp, and Ottawa Hlth Res Inst, Canada; 5Canadian Immunodeficiency Res Collaborative, Toronto; 6Ctr for Communicable Diseases and Infection Control, Publ Hlth Agency of Canada, Ottawa; and 7Univ Hlth Network, Toronto, Canada

    "Isolated semen HIV RNA shedding was detected in 12 of 25 (48%) participants despite effective HAART, and at a high level (>5000 copies/mL) in 4 of 25 (16%). Isolated semen shedding was detected at 19 of 116 (14%) visits with an undetectable blood viral load, and was associated with the pre-therapy semen HIV viral load. Public health messages and policy must be tailored carefully to reflect this reality."

    During the Q&A two people questioned the use of DNA rather than PCR saying that the assay may not as reliable and the percent of patients with detectable virus in semen despite undetectable in blood was higher than seen in other studies.

    Background: The semen of an HIV-infected man is the most common mode of HIV transmission. HAART often results in an undetectable blood HIV RNA viral load, and it has been suggested that there may be no risk of sexual transmission in this context. However, the influence of effective HAART on HIV levels in semen is unclear and requires further study.

    Methods: We performed a prospective, longitudinal study of semen and blood HIV RNA levels after HAART initiation, and a cross sectional study in men on long-term effective HAART. Effective HAART was defined as the achievement of an undetectable blood viral load. Anti-retroviral drug concentrations were measured using high-performance liquid chromatography (HPLC) and HIV genotype and sequence analysis were performed using real-time polymerase chain reaction (RT-PCR).

    Results: In 25 participants followed prospectively after HAART initiation, the blood viral load was consistently undetectable by week 16. Isolated semen HIV RNA shedding was detected in 12 of 25 (48%) participants despite effective HAART, and at a high level (>5000 copies/mL) in 4 of 25 (16%). Isolated semen shedding was detected at 19 of 116 (14%) visits with an undetectable blood viral load, and was associated with the pre-therapy semen HIV viral load. Semen isolates did not contain drug resistance mutations, and were infectious in vitro. Isolated semen HIV shedding was not associated with antiretroviral drug concentrations in semen plasma. In 13 participants with much more prolonged suppression of the blood viral load (median; 126 months), isolated semen HIV shedding was detected in 4 of 13 (31%) participants.

    Conclusions: Although effective HAART often eliminated HIV RNA from the semen, isolated HIV semen shedding was common, even after extremely prolonged suppression of blood viral load. Public health messages and policy must be tailored carefully to reflect this reality.

    Detection of HIV-1 RNA in Seminal Plasma Samples from Treated Patients with Undetectable HIV-1 RNA in Blood Plasma

    Anne-Genevieve Marcelin*1, R Tubiana1, S Lambert-Niclot1, G Lefebvre2, S Dominguez1, M Bonmarchand1, D Vauthier-Brouzes1, F Marguet1, G Peytavin1, C Poirot1, and the Pitie-Salpetriere AMP a Risque Viral Study Group 1Hosp Pitie-Salpetriere, P
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    Feb 23, 2010 4:15 AM GMT
    and on and on....
  • cobra2814

    Posts: 28

    Feb 23, 2010 4:28 AM GMT

    As described in the July 26, 2008, issue of The Lancet, Australian researchers used a mathematical model to quantify the small transmission risk under the circumstances described in the Swiss statement. Assuming that each couple engaged in 100 sexual acts per year, they calculated the cumulative annual probability of transmission as .22% for female-to-male transmission, .43% for male-to-female transmission, and 4.3% for male-to-male transmission. In a population of 10,000 serodiscordant couples, this would translate to 215 expected instances of female-to-male transmission, 425 instance of male-to-female transmission, and 3,524 instances of male-to-male transmission about four times greater than the risk when using condoms.

    This is without condoms. Furthermore, shall I say "lies, damned lies, and statistics" since you're using the same thing here? To your point, this is a mathematical model, not a real world study. You can't argue that mathematical models are useless in one post and then use their results to support your argument in another. Can't have it both ways. Choose.



    "Although we agree that effective antiretroviral treatment which leads to undetectable viral load is likely to have a substantial effect on reducing infectiousness," the researchers concluded, "our analyses suggest that it should not replace condoms."


    This summarizes my thoughts on the issue perfectly. Just to be clear.



    Along similar lines, researchers at the University of Bern set out to conduct a systematic review of medical literature to verify the Swiss statement (AIDS 2008 abstract THAC0505). Looking at more than 200 published articles and 100 abstracts, they found none that exactly mirrored the conditions described in the statement. In the one study that included treated patients with undetectable viral load, no cases of HIV transmission were reported. In four studies of untreated patients with HIV RNA below 400 copies/mL, only one transmission occurred (from an individual with a viral load of 362 copies/mL). No transmissions were identified from individuals with HIV RNA below 40 copies/mL.


    So there you have it. The lowest viral load that has been proven and recorded to show transmission is 362 copies/mL. Undetectable these days is typically less than 50. I appreciate the points about viral shedding in the semen, and its potential to possibly infect. But until you can show me a controlled study that proves this occurs rather than mere anecdotes, you are wrong to say it does happen unequivocally.
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    Feb 23, 2010 4:31 AM GMT
    cobra2814 saidGetting tired of quoting, but this is directed at rightasrain:
    and the risk of getting infected is not something to be feared when an individual is undetectable.


    just as you are wrong and almost criminally dangerous in saying the above