A panel of Swiss HIV experts have declared that HIV-positive people with undetectable viral load are sexually non-infectious. This is the first time that medical experts anywhere have agreed that well-suppressed blood viral levels are a reliable measure of sexual infectivity. This will be controversial, but it’s a fascinating development.
The statementâ€™s headline statement says that â€œafter review of the medical literature and extensive discussion,â€ the Swiss Federal Commission for HIV / AIDS resolves that, â€œAn HIV-infected person on antiretroviral therapy with completely suppressed viraemia (â€œeffective ARTâ€) is not sexually infectious, i.e. cannot transmit HIV through sexual contact.â€
It goes on to say that this statement is valid as long as:
- the person adheres to antiretroviral therapy, the effects of which must be evaluated regularly by the treating physician, and
- the viral load has been suppressed (< 40 copies/ml) for at least six months, and
- there are no other sexually transmitted infections.
The experts noted the essential conundrum of proving the negative hypothesis (i.e. proving that something can never happen) but said “The situation is analogous to 1986, when the statement â€˜HIV cannot be transmitted by kissingâ€™ was publicised. This statement has not been proven, but after 20 yearsâ€™ experience its accuracy appears highly plausible.”
A report on Aidsmap.com canvasses the implications of the announcement for medical practitioners, people with HIV, HIV prevention and the legal system.
As one colleague observed today, “I guess we know now what they’ll be fighting about at this year’s International AIDS Conference.”