HIV Transmission Risks with Controlled Viral Load

Q: HIV Transmission Risks with Controlled Viral Load

Dear readers, I. <Regarding whether the possibility of transmission is low?> A： When patients consistently adhere to their medication regimen and maintain an undetectable viral load over time, the risk of transmission is significantly reduced. II. <Regarding wh

Issues related to HIV infection?

Hello, doctor! If a partner has HIV but is on medication and their viral load is almost undetectable, does this mean that the risk of transmission is low? Additionally, if sexual intercourse occurs with the consistent use of condoms, is it unnecessary to consider purchasing pre-exposure prophylaxis (PrEP) out of pocket?

Mr. Chen, 20~29 year old female. Ask Date: 2017/12/05

Dr. Liao Zhongxin reply Internal Medicine

Dear readers,
I.

A: When patients consistently adhere to their medication regimen and maintain an undetectable viral load over time, the risk of transmission is significantly reduced.
II.

A: Unsafe behaviors refer to engaging in sexual activities with strangers or sharing drug paraphernalia, which increases the risk of sexually transmitted infections and HIV.
Therefore, if one consistently uses condoms and follows a regular medication schedule, there is no need to take preventive medications.
Thank you!

Reply Date: 2017/12/05

More Info

When it comes to understanding HIV transmission risks, particularly in the context of a partner who is HIV-positive but has an undetectable viral load due to consistent medication adherence, the risk of transmission is significantly reduced. This concept is often summarized by the phrase "Undetectable = Untransmittable" (U=U). This means that if an HIV-positive individual maintains an undetectable viral load (typically below 200 copies/mL), the likelihood of transmitting the virus to an HIV-negative partner during sexual activity is extremely low.

The science behind this is based on extensive research that has shown that effective antiretroviral therapy (ART) can suppress the viral load to undetectable levels, thereby preventing the virus from being transmitted through sexual contact. This is a crucial point for couples where one partner is HIV-positive and the other is HIV-negative. If the HIV-positive partner is adherent to their medication regimen and has regular check-ups to monitor their viral load, the risk of transmission is negligible.

In your case, if your partner has been consistently taking their medication and their viral load is undetectable, the risk of HIV transmission during sexual intercourse is very low, even if you engage in unprotected sex. However, it is still advisable to use condoms as an additional precaution, as they also protect against other sexually transmitted infections (STIs) and provide a barrier against potential exposure to HIV if the viral load were to fluctuate.

Regarding the use of pre-exposure prophylaxis (PrEP), it is a preventive strategy for individuals who are at high risk of contracting HIV. If your partner's viral load is consistently undetectable and you are using condoms correctly and consistently, the necessity for PrEP may be reduced. However, it is essential to have an open and honest discussion with your healthcare provider about your specific circumstances, including any potential risks and your comfort level with those risks.

In summary, if your partner is HIV-positive, adheres to their ART, and maintains an undetectable viral load, the risk of transmission is very low. Using condoms can further reduce this risk and protect against other STIs. If you have concerns or if your sexual practices change, consulting with a healthcare provider about the potential benefits of PrEP and regular testing is a prudent approach. Regular communication with your partner about health status and safe practices is key to maintaining a healthy relationship.

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