{"id":577,"date":"2015-01-31T08:00:27","date_gmt":"2015-01-31T08:00:27","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/?p=577"},"modified":"2017-08-21T11:57:06","modified_gmt":"2017-08-21T11:57:06","slug":"primary-care-corner-with-geoffrey-modest-md-hiv-transmission-in-serodiscordant-couples","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2015\/01\/31\/primary-care-corner-with-geoffrey-modest-md-hiv-transmission-in-serodiscordant-couples\/","title":{"rendered":"Primary Care Corner with Geoffrey Modest MD: HIV transmission in serodiscordant couples"},"content":{"rendered":"

By: Dr. Geoffrey Modest<\/strong><\/p>\n

One issue that comes up a lot is the transmissability of HIV in serodiscordant couples when the HIV-positive person has a suppressed viral load. A letter-to-the-editor was just published, reviewing 6 relevant studies (see doi.org\/10.1097\/QAI.0000000000000471<\/strong>). Lacking the best data, the researchers assumed that a surrogate for suppressed viral load was if the HIV-positive partner had been on combined antiretroviral treatment (cART) for >6 months (since usually the viral load is suppressed by then). They found:<\/p>\n

–At most one transmission in 113,480 sex acts, of which 17% were not condom-protected.
\n–For that one transmission, data were not adequate to see if it happened before or after than 6-month mark
\n–So, their estimation varies as follows:
\n–Case 1: no transmission after 6 months — upper bound of risk-per-sex act was 8.7 per 100,000
\n–Case 2: 1 transmission after 6 months — upper bound of risk-per-sex act was 13 per 100,000<\/p>\n

Then, they added the results of the PARTNER study presented at the CROI (conference on retroviruses and opportunistic infections) meeting in Boston in 2014 (see here<\/a>), which looked at 767 HIV-discordant couples (40% gay) where there was condom-less sex and the HIV-infected partner had a viral load –NO transmissions so far!!! (the study will go on to 2017 — this is only an abstract of an interim report from the meeting)
\n–So, by adding this data to the above 6 studies, the estimates for case 1 above decreased to 5.2\/100,000 sex acts and from case 2 to 7.9\/100,000 sex acts<\/p>\n

So, this is helpful. However, there needs to be more data on gay couples, since most of the above is on heterosexual couples. I do have some concern about reported discordance between suppressed viral load in blood and in semen. The studies I’ve seen are mostly in MSM (men who have sex with men), so I do have concern about the relative lack of data in the above studies about MSM. One recent article from Boston found that of 83 men with undetectable HIV in blood, 25% had HIV in their semen with HIV levels of 80 to 2560 copies\/mL, with multivariate analysis showing sexually-transmitted infections\/urethritis and unprotected insertive anal sex with an HIV-infected partner to be independent predictors of seminal fluid HIV detection (see AIDS 2012, 26:1535\u20131543\u200b<\/strong>)\u200b. Other studies have found detectable semen HIV levels in MSM with non-detectable plasma HIV levels in those with herpesvirus infections (eg CMV or EBV). But the study above is pretty reassuring, suggesting that transmission is still pretty rare (though likely non-zero). So, I think patients should still be warned that there is still a possibility of getting HIV infection if they don’t use condoms, as well as the variety of other potential sexually-transmitted infections.<\/p>\n","protected":false},"excerpt":{"rendered":"

HIV transmission in serodiscordant couples […]<\/p>\n

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