Question

Is transmission a risk with a very low viral load if I am not on ART

7 August 2020. Related: All topics, CD4 and viral load, HIV transmission.

Hi! I was recently diagnosed in Brazil with HIV and have not yet started  antiretroviral therapy.

My Viral Load test was only 28 copies / mL.  (I never used antiretrovirals). 

So, with this 28 copies/mL of viral load, can I transmit HIV if I have sex without a condom? 

Thank you very much.

Answer

Answer: Simon Collins

Hi there

Thanks for your question and for letting us answer this online.

First, how are you doing? HIV is still usually a shock but if you are finding this difficult now, it will get easier.

Secondly, this is an interesting question but other people have also asked.

Technically, at the point that your viral load was tested, your partner would have a similar 100% protection as someone taking treatment with the same viral load.

In practice though, this is not the same because not being on treatment will make it easier for your viral load to increase to higher levels that would cause a risk. Maybe the next day it might be 200 or 2000. Even if it drops lower again, you will never know the actual risk at any time.

Even if you don’t start ART now and the next test in a few months is still low, it is very likely that at some time your viral load will steadily increase. If this happened between tests you could easily have a viral load of several thousand for several months before finding out. During this time your partners would definitely be at risk.

If you are able to start treatment (and you decide to do this) then your viral load would then stay undetectable and your partners would have zero risk.

I am not sure whether treatment guidelines in Brazil allow this but please talk to your doctor about this.