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.”