Claims by Swiss experts that HIV-positive individuals who are on antiretroviral treatment and free of other STIs are not sexually infectious are being treated cautiously by local HIV/AIDS organisations.
A paper published this week by the Swiss Federal Commission for HIV/AIDS stated that, “after review of the medical literature and extensive discussion”, the SFCHA found that “an HIV infected person on antiretroviral therapy with completely suppressed viremia is not sexually infectious”. That is, as long as the individual has had undetectable viral loads for six consecutive months, has never missed a dosage and is free of any other STIs.
ACON Community Health director Nick Corrigan said the statement “largely confirms ACON’s established policy that a person with an undetectable viral load was unlikely to pass on HIV”.
“However, it is difficult to know your viral load at a particular point in time and the fact that viral load can fluctuate means that this is not an infallible risk reduction strategy and should not be used as an alternative to condoms and lube in the gay community,” he added.
The studies referred to in the statement are based on heterosexual couples. It is estimated that HIV is between 10 and 30 times easier to transmit through anal rather than vaginal sex.
PLWHA CEO Rob Lake said the information would have its uses. “This information is useful for heterosexual Australians with HIV in monogamous serodiscordant relationships, particularly in considering their options regarding conception,” he said.
“But is also useful for gay men in monogamous relationships and might help with some of the stress and concern about possible infection within those relationships.”
Both Corrigan and Lake warned the gay community not to become complacent in light of the claims.
“Although a person on successful HIV treatments is much less likely to pass on HIV, it can and does happen,” Corrigan said.
“Twenty-one men in a recent Australian study became HIV-positive after having unsafe sex with a man they knew to be positive. Nine of these men reported that their partner’s viral load was undetectable.”
“This is not a change to the notion of what is safe sex,” Lake added.
“We have strong evidence in Australia that a consistent message about the use of condoms and lube for anal sex has had a major impact in limiting the sexual transmission of HIV.
“This is useful information which highlights some areas we’d like to know more about … but, in short, we agree with the UNAID and World Health Organisation’s response which advises caution and reinforces existing safe-sex guidelines.”