COMMENTARY

In HIV, Viral Load Matters and PrEP Is Still Critical

Charles P. Vega, MD

Disclosures

August 17, 2018

Hello. I'm Dr Charles Vega, and I am a clinical professor of family medicine at the University of California at Irvine. Welcome to Medscape Morning Report, our 1-minute news story for primary care.

Undetectable HIV is untransmittable. That is the upbeat conclusion from PARTNER2, a study of 972 serodiscordant gay couples over 1600 couple-years which showed zero linked transmissions from condomless sex when the HIV-positive partner had a suppressed viral load.

There were 15 HIV seroconversions during the study, but in all of these cases, the viruses were genetically distant from one another.

This is welcome news but it should come with some warnings. While men in this study underwent viral load testing every 6-12 months, there is the potential for men to develop detectable viral loads between assessments. Other sexually transmitted infections are still a concern, and this study should not change recommendations for use of condoms, especially for men with multiple partners.

And finally, CDC strongly recommends the use of preexposure prophylaxis (PrEP) for seronegative men. This continues to be important advice, especially for high-risk men with multiple partners or a partner whose viral load is unknown.

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