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What Does Undetectable Viral Load Mean?

Hey there Guys,

Today I received an important article that I thought was vital to share.

Recently there has been many questions poised about success of effective treatment of HIV when it comes to counts of viral load. As I mentioned in my video “What does viral load mean?” I discussed how viral load is a measure of the quantity of HIV virus able to be detected in blood. One question that has never fully been answered is if virus in not capable of being detected in blood does that mean it’s equally as low in other body fluids such as semen.

A recent study in Boston has show that even in people with undetectable viral load in their blood, one quarter did have detectable viral load in their semen. As noted at Edge On The Net:

“Although the potential prevention benefits are compelling, this study demonstrates that even achieving an undetectable viral load in your or your partner’s blood doesn’t necessarily prevent HIV from being transmitted during sex.”

Also noted in the study was that having a sexual infection at the same time increased the risk of having detectable viral load in semen.

Importantly, the study findings show a very strong association with detectable HIV in semen and having a current sexually transmitted infection (STI). Six of the eight men whose HIV were undetectable in blood but detectable in semen had a urethral STI. After adjusting for other factors the researchers concluded that men who had an STI and/or urethritis were 29 times more likely to have viral discordancy.

So what does this mean?

For me this study highlights two important issues.

Firstly we can not rely on the previously held belief that non detectable viral load of blood can be extrapolated to equally low levels of HIV in semen. We need to acknowledge the value of safe sex even when people are on effective treatment for HIV infection. Safe sex can also reduce, but not eliminate, the risk of other sexual infections which can increase the viral count in semen but also the risk of infection with HIV in examples like Chlamydia or Gonorrhoea in the throat.

For sero-discordant partners it’s important to understand these potential risks and to make decisions based upon the latest information.

The study also highlights the importance of regular sexual health check-ups. Early diagnosis of sexual infections leads to early treatment and reduction in further risk of other infections.

This very fact was highlighted to me recently with a patient who saw me with anal pain. Despite practising safe sex with his regular partner what was thought to be haemorrhoids ended out being anal Chlamydia. Through careful discussion we were able to establish that perhaps even with condom usage, insertion of fingers may have lead to infection. Thankfully the treatment was very straight forward and he is back in vibrant health.

Treatment for Chlamydia is simple and straight forward, treatment for HIV secondary to Chlamydia infection is not.

If you have any symptoms such as sore throat, anal pain or discomfort when passing urine it’s important not to discount the potential for a sexual infection. Be sure to talk with your doctor and get tested.

Even when symptom free the current recommendations for sexual check-ups are once a year, or every six months (or sooner) if you have had more than 5 partners in a year, picked up off the internet or attended a sex on premise venue. Be open with your doctor about the sex you have had as it will guide testing i.e. throat swabs if you have had oral sex, and anal swabs if you have had fingers, toys or cocks in your ass.

I have certainly found this study to be an eye opener.

Do you have any thoughts or questions? Feel free to leave a comment below or send me an email.

Yours in good health.

Dr George

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