Undetectable Viral Load — Not a Guarantee Against Transmitting HIV

Charles B. Hicks, MD


AIDS Clinical Care 

In This Article


Although there is no doubt that ART significantly decreases the likelihood of HIV transmission, these data indicate that the risk for HIV transmission is not eliminated by suppressive ART. Shedding of virus in the male genital tract is not uncommon, even in men with consistently undetectable plasma HIV RNA. Among such men, STIs, urethritis, and genital inflammation significantly increase the likelihood of HIV shedding in semen, and the timing and frequency of this shedding appear to be unpredictable. Furthermore, previous studies have shown no clear association between the presumed penetration of specific antiretrovirals into the genital tract and the likelihood of detectable virus in semen. Thus, despite the fact that the threshold level of genital-tract HIV necessary for transmission is not known, caution is warranted. Recommending safer sex (and procreation) practices for all HIV-infected patients, even those with suppressed plasma HIV RNA, seems prudent.


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