It is now well known that the use of HIV treatment not only improves the health of people living with HIV, but is also a highly effective strategy to prevent HIV transmission. This is because HIV treatment can reduce the amount of virus viral load in the blood and other bodily fluids such as semen and vaginal and rectal fluids to undetectable levels. In addition to taking HIV medications, regular medical visits are important to monitor viral load to make sure it stays undetectable, and to receive other medical support.
When HIV replication is controlled, the viral load in the blood and bodily fluids decreases. Research tells us that as the viral load decreases, so does the risk of HIV transmission. When successful treatment lowers the viral load to undetectable levels, this can greatly reduce or eliminate the risk of HIV transmission.
ART usually consists of a combination of at least three antiretroviral drugs taken daily. The power of ART today is so profound that many people who start effective treatment soon after becoming HIV positive will have a
Undetectable viral load and hiv transmission heterosexual normal life span. For most people the virus becomes so well controlled that within three to six months of starting treatment the amount of virus in their blood Undetectable viral load and hiv transmission heterosexual undetectable by routinely used tests.
Most viral load tests used in Canada cannot detect HIV in the blood if there are less than 40 to 50 copies of the virus per ml. However, the virus is still present at very low amounts in the body when the viral load is undetectable.
Regular testing and treatment for sexually transmitted infections STIs is also important since this strategy does not protect against STIs. A person on ART needs to work with their doctor to determine an appropriate schedule for medical check-ups and viral load monitoring. After starting treatment the viral load needs to become and remain undetectable for this approach to provide protection.
When a person first begins treatment, it usually takes three to six months for the viral load to become undetectable. Most people will eventually have an undetectable viral load if they have a drug combination that is effective against their strain of HIV and take it as prescribed by their doctor. The viral load should remain undetectable for at least six months before depending on this approach as an effective HIV prevention strategy.
A person must continue to have high adherence to treatment to maintain an undetectable viral load over time. The only way to know if the viral load remains undetectable over the long term is to have regular viral load tests.
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This most commonly happens when someone has low adherence to medications, but it can also occur due to drug resistance or drug toxicity. Depending on the reason the treatment failed, a person may require a change in treatment, or may benefit from adherence counselling, to bring their viral load back down to undetectable levels. The best options for moving forward should be discussed with a doctor. Research conducted in serodiscordant couples where one partner is HIV positive and the other is HIV negative shows that, when used consistently and correctly, the use of ART to maintain an undetectable viral load is a highly effective strategy to prevent the sexual transmission of HIV for both heterosexual and same-sex male couples.
Evidence from this research shows that when people on ART are engaged in care and maintain an undetectable viral load, they
Undetectable viral load and hiv transmission heterosexual not transmit HIV through sex. How does HIV treatment and...
The first study to show that ART and an undetectable viral load has a major prevention benefit in serodiscordant heterosexual couples was the randomized controlled trial known as HPTN In the final analysis, which included 1, serodiscordant heterosexual couples half of whom were followed for over five and a half yearsno HIV transmissions occurred between couples in the study when the HIV-positive partner was on ART and had an undetectable viral load.
In total, eight transmissions occurred between couples while the HIV-positive partner was on ART; however, in all eight cases the viral load was detectable, despite being on ART. Four transmissions occurred in the first three months after the HIV-positive partner started treatment, before the viral load was undetectable.
The other four happened when treatment failed to maintain the viral load at undetectable levels.
In addition to these eight transmissions, there were 26 people who acquired HIV infection from a sex partner outside of the primary relationship, showing that
Undetectable viral load and hiv transmission heterosexual a serodiscordant couple in which the HIV-positive partner is on ART with an undetectable viral load, the main risk of HIV transmission comes from outside the relationship. The first phase of the study included heterosexual and same-sex male couples, and the second phase continued with only same-sex male couples.
In this study there was a large number of unprotected sex acts no condoms, PrEP or PEP when the viral load was undetectable — approximately 36, among heterosexual couples and over 70, among same-sex male couples enrolled in the study.
However, there were 16 new HIV infections 15 gay men and one heterosexual person that were transmitted from a sex partner outside of the relationship. An observational study similar to PARTNER, called Opposites Attract, also found no HIV transmissions between serodiscordant same-sex
Undetectable viral load and hiv transmission heterosexual couples when the partner was on treatment and maintained an undetectable viral load despite over 12, condomless anal sex acts.
Between the two studies there were over 8, condomless anal sex acts between serodiscordant male couples during a period when at least one partner had an STI, and no HIV transmissions occurred.
All participants in these studies were engaged in regular healthcare appointments to check viral load, test for STIs, and receive adherence and prevention counselling. They were also treated for STIs when needed. These comprehensive supports are an important part of regular follow-up care while on ART. The results of these and earlier studies provide a strong body of evidence showing that people living with HIV who are adherent to ART and engaged in regular healthcare, with a sustained undetectable viral load, do not transmit HIV sexually.
If a pregnant person starts HIV treatment prior to or very early in pregnancy and maintains an undetectable viral load during pregnancy and delivery, they will not transmit HIV to their baby. However, it is possible to transmit HIV through breastfeeding sometimes called chestfeeding because human milk can contain HIV even when the viral load is undetectable.
A French cohort study found that no HIV transmissions occurred among 2, infants born to women who were on treatment before they conceived and throughout their pregnancy, and who had an undetectable viral load at delivery.
HIV testing is important for people who are pregnant or considering becoming pregnant, so that people
Undetectable viral load and hiv transmission heterosexual test positive can begin treatment and reduce or eliminate the risk of passing HIV to their babies. The risk of transmitting HIV through breastfeeding while on treatment and maintaining an undetectable viral load is very low, but not zero.
While an undetectable viral load greatly reduces the risk of transmission, there have been some cases of HIV transmission among breastfeeding women who had undetectable viral loads. Canadian guidelines recommend that HIV-positive parents
Undetectable viral load and hiv transmission heterosexual their babies formula to prevent transmission.
However, experts recommend that people who are on treatment and maintaining an undetectable viral load who have a strong desire to breastfeed should receive clinical support to do so as safely as possible. An HIV-positive person who is engaged in care, on ART and has a sustained undetectable viral load is also considerably less likely to pass HIV through injection drug use. The available research suggests that this strategy is effective at preventing HIV transmission among people who inject drugs; however, there is not enough evidence to conclude that there is no risk.
Having an undetectable viral load...
Two ecological studies from Vancouver and Baltimore reported on reductions in new HIV infections over time and found an association with a reduction in the community viral load of people who inject drugs. Although it is likely that increased uptake of ART is partly responsible for the observed decline in the number of new infections, it is difficult to know how much of this change can be attributed to an increase in harm reduction services that also occurred during this period.
A recent cohort study in India among 14, people who inject drugs and 12, men who have sex with men found a clear correlation between estimated HIV incidence and both community-level treatment coverage and viral suppression. This study found significant correlations at the community level, but since
Undetectable viral load and hiv transmission heterosexual was not designed to look at individual risk of transmission, Undetectable viral load and hiv transmission heterosexual estimate of effectiveness was available.
Although the use of ART to maintain an undetectable viral load works regardless of whether condoms or PrEP are used, everyone should be able to choose a prevention strategy that works best for them. This strategy is one of several highly effective options for preventing sexual HIV transmission; however, it does not offer protection against STIs such as herpes, chlamydia or syphilis.
Condoms are the only effective strategy to help prevent STIs. For people who inject drugs, other prevention programs and strategies such as the distribution and use of new injecting equipment are important to help prevent HIV transmission, as well as other blood-borne infections such as hepatitis C. Undetectable viral load and HIV sexual transmission. The Power of Undetectable: What you need to know about HIV treatment as prevention.
Updated results from two studies continue to show that antiretroviral treatment and an undetectable viral load is a highly effective HIV prevention strategy — CATIE News. Views from the front lines: Pregnancy and infant feeding — Prevention in Focus. HIV-1 viral load blips are of limited clinical significance. Journal of Antimicrobial Chemotherapy.
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Prevention of HIV-1 infection with early antiretroviral therapy. New England Journal of Medicine. Antiretroviral therapy for the prevention of HIV-1 transmission. Journal of Acquired Immune Deficiency Syndromes. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive
Undetectable viral load and hiv transmission heterosexual therapy.
Journal of the American Medical Association. Amsterdam, the Netherlands, Viral suppression and HIV transmission in serodiscordant male couples: Is transmission of HIV-1 in non-viraemic serodiscordant couples possible? HIV treatment as prevention among injection drug users. HIV treatment as prevention among people who inject drugs — a re-evaluation of the evidence. International Journal of Epidemiology. The role of sexually transmitted diseases in HIV transmission.
No perinatal HIV-1 transmission from women with effective antiretroviral therapy starting before conception. HIV transmission from mothers on antiretroviral therapy to their infants during breastfeeding in Rural Tanzania. Antiretroviral regimens in pregnancy and breast-feeding in Botswana.
Antiretroviral prophylaxis for breastfeeding transmission in Malawi: Is breastfeeding
Undetectable viral load and hiv transmission heterosexual equipoise option in effectively treated HIV-infected mothers in a high-income setting? Community viral load, antiretroviral therapy coverage, and HIV incidence in India: Programming Connection case study: Smartphone intervention found helpful for young men taking PrEP.
A mile in our moccasins [video] — HIV education and awareness through lived experiences and an Indigenous lens. Eliminating hepatitis C among people who use drugs: How do I tell my kids?
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Evidence shows that HIV-positive people who are on treatment, engaged in care, and have an ongoing undetectable viral load: The consistent and correct use of ART to maintain an undetectable viral load
Undetectable viral load and hiv transmission heterosexual Having an undetectable viral load also prevents sexual transmission of HIV. The HPTN study looked at 1, heterosexual serodiscordant couples. Heterosexual serodiscordant couples have an almost non-existent risk of HIV transmission if the HIV-positive partner has an undetectable viral.
Men who had an undetectable viral load and believed that having an undetectable HIV transmission is further amplified when medication nonadherence . Viral load and heterosexual transmission of human immunodeficiency virus type 1.