Does reducing your HIV to "undetectable" make you "non-infectious"?
This, in the words of New York University’s Dr. Roy Gulick, is one of
the days "$64,ooo questions." And while eradication researchers play
hide-and-seek with the virus, prevention experts dance around a
discussion of the issue fearing it might license unsafe sex. A Swiss
study published in the August AIDS is likely to stir the pot.
Looking at 44 HIV positive men on combo therapy, Dr. Pietro Vernazza of
the Institute for Clinical Microbiology found that the viral levels not
only in the blood but in their semen went "undetectable". Protease-based
regimens, he concluded, "can be expected to have a beneficial impact on
the spread of the epidemic."
Such pronouncements give Gulick pause. "These data are encouraging.
But it’s premature to suggest these men are not infectious," he said,
adding that related research has detected viral DNA in seminal fluid.
"You still have genetic material of the virus. Whether that means you
can transmit, we haven’t yet learned." In addition, semen contains
lymphocytes and other cells that may harbor infectious HIV.
Meantime, recent rates of rectal gonorrhea among gay men, according
to the CDC, are up, indicating that safe sex is down. That ridding the
blood of measurable HIV is being seized on as a reason to ditch condoms
was already everyone’s nightmare, and this pre-eradication trend is a
wakeup call. "There’s a tendency around the eradication news to make
enormous assumptions that can be life-threatening," GMHC’s Richard
Elovich said. "I would be very cautious about concluding anything about
prevention when what we’re talking about is treatment."
Still, the belief that HIV may be harder to transmit has important
implications, said psychologist Walt Odets. "It’s seductive because it
supports feelings everyone wants. For the positive, it’s that they
aren’t ‘contaminated,’ but desirable and not a danger to others; for the
negative, that their partners aren’t ‘contaminated’ and that they
themselves are not in danger. This conjecture about nontransmissibility
gives such feelings a plausibility as yet unsupported by the facts."