Undetectable = Untransmittable?

[Lucky]

There was some talk that a person with HIV who has an undetectable viral load would be less likely to transmit the virus, but who wants to risk their health on talk?

Now it looks like it might be proven to be true. So says HIV Plus magazine. But what it is shockingly wrong with their statement is that they provide absolutely no proof of what they say. No study is explained or even mentioned. They make a reference to the Prevention Access Campaign. I guess you are supposed to visit preventionaccess.org/undetectable, so let's do that now...

Well, they quote people saying the same thing, but I see no links to any study where one can analyze the data and see if this statement is something you could believe. In the meantime, condoms do this too.

 

 

[AdamSmith]

You express surprise that a press organ may have made an egregious error in reporting on its supposed specialty.

Is this the first time you have read a newspaper?

[Guest bobbalino]

The banner is a little misleading but mostly true based on a large longitudinal cohort study of serodiscordant couples ... as time passes without evidence of sexual transmission in these relationships, the legitimacy of declaring negligible risk becomes improved. Still no transmissions to date in this cohort, based on constancy of viral suppression.

The concept of confidence intervals in statistical analysis pre-empts the possibility of declaring absolute zero risk. Some knowledge translators do not get caught up in this splitting of hairs. For them, the data are satisfactory in terms of pronouncing zero risk.

For scientists, the lowest-likely estimate is zero risk, but no transmission so far does not equal zero risk of transmission.

It is comparable to the denialism debate about the relationship between the virion scientists purport is HIV and the presence of clinical symptoms and other markers responsible for the illness that is labelled HIV. The confidence it is true is high, one in multiples of millions it could be measurement error of correlation, reducing the legitimacy of causation, but not absolutely incontrovertibly true. Well, I don't need to be convinced.

Again, for laypersons interpreting the findings, well, they might stretch it some degree. It is promising news, though.

A few caveats, however, listed as follows. The cohort follow-up is ongoing and the record of zero transmissions may not endure. There is lacking 100% determination of PEP/PrEP uptake in seronegative partners. Some partners have acquired HIV but the serotype evidence points to other than the primary (poz) partner. The researchers are more confident in the transmission risk approaching progressively more towards absolute probabilistic zero for heterosexual couples, whereas this trend is lagging behind somewhat for male couples because they represent a smaller proportion of the overall cohort. Finally, these are primary attachment relationships and the results are predictive for such, although it is somewhat reasonable to extend to casual sexual relationships. The latter are very difficult to follow systematically in a large cohort study over an extended period of time.

Finally, the left side of the banner, if taken literally, suggests needle-sharing poses no risk. Wrong ... VL under 200 means an average of 100 virions per ml, or up to half a million viral particles in the average HIV+ person's blood supply. Unprotected sex, well progressively more and more OK, but keep the messages sharp, no pun intended.

[Guest bobbalino]

Forgot to add: it is the PARTNER study, a multi-site collaborative research project in 14 Europe-based clinics.

[redxs]

I think in UK we are coming round to this way of thinking, lots of guys promote themselves on Grindr etc as positive and undetectable or on PREP and for many there is no issue now with this.

http://i-base.info/htb/30108

[Lucky]

bobbalino, you found the research that this site did not provide. Thanks.