Are condoms needed when viral load is undetectable?
At a recent medical conference, doctors debated whether men living with HIV who have an undetectable viral load should be advised to wear condoms. Dr Lisa Winston argued that condoms were still needed for three main reasons:
Condoms prevent transmission of other sexually transmitted infections (as well as HIV).
These infections are not always easy to treat (e.g. drug-resistant gonorrhoea) or without serious consequences (e.g. hepatitis C).
HIV that is undetectable can become detectable, for a variety of reasons including missing doses of antiretrovirals and concurrent illnesses.
HIV transmission is theoretically possible when viral load is undetectable in plasma or semen. "If you observe enough people for a long enough period of time, you probably will see occasional transmissions – they will be rare, but they are likely to occur," Dr Winston said. "What is your appetite for risk when advising patients?"
Countering these arguments, Dr Roy Gulick reminded the audience of the many studies of HIV transmission within serodiscordant couples which have not identified any linked infections when the HIV-positive partner was on treatment with an undetectable vial load.
These include the key randomised study known as HPTN 052, the PARTNER study which has data on 58,000 sex acts and a meta-analysis of six studies with a total of 7000 couples.