Question
Can I get use HIV treatment to protect my negative partner?
15 June 2011. Related: Access to treatment, All topics, HIV transmission, Starting treatment.
Hey there guys. Thanks for such a fantastic work and so much help and information.
I am HIV poz man and I’m not on medication. My viral load is around 55,000 and CD4 is 550. I have now been in a relationship with negative person (we are a gay male couple). He has completely accepted my situation in the most caring, compassionate and adult way. Very refreshing!!!
I have been considering to ask my doctor to go on treatment as I want to reduce any possiblities of infecting my partner even though we play safe every time and so far no problems. Am I allowed to start treatment whenever I want in the UK? Can I ask for it? Even though we play safe we have been many time in the heat of the moment about to do a silly thing. We are all humans after all.
Second question is regarding oral sex. What are the chances of passing the virus after 6 months of successful treatment through oral sex in case of ejaculation in the mouth? I’m aware that there might not be enough data supporting such inquiry but some ideas would help.
Third question. What are the best thin yet strong condoms out there in the market. Something that doesn’t take the sensitivity away.
Thanks guys I would appreciate all your help.
Answer
Hi
Thanks for your question and allowing us to post the answer online.
The first question is easiest to answer if you are in the UK. BHIVA guidelines include the protective impact of HIV drugs for people in serodifferent partnerships as a reason to consider earlier treatment at higher CD4 counts. [1]
Considerably more research has supported the protective impact of treatment, including the recent HPTN 052 study [2]. I’d therefore expect the next update from BHIVA (2008 is pretty out of date) to strengthen the support of treatment as prevention.
Your doctor should be happy to discuss this with you but if you have any difficulties, please let us know and we can help.
The second question is slightly more complicated to answer. This is because scientifically risks are rarely ever given as zero. This is because you cannot define a negative – ie prove that something can never happen. However, in the real world, the risk of transmission from oral sex is generally low. The 5% of cases reported from oral sex are explained by both a high likelihood of very high viral load and poor oral health (bleeding gums, cuts, ulcers etc).
Once your viral load is undetectable, the risk would be close to zero if your partner has good gum health etc.
An indication of the level of this risk in a health care setting is that oral sex with a person with undetectable viral load is considered too low a risk for PEP (post Exposure Prophylaxis) to be prescribed in the UK.
PEP is where your partner would be given a month of HIV drugs if there was a worry that he had been exposed (ie if a condom broke now when you are not on treatment).
I don’t have data to answer the third question. There might be comparative studies online but I couldn’t find them.
This is a case where you may just have to experiment and find which ones work best for you.
These links to the GMFA include more information on condoms and where condoms are free and can be bought online.
References
1. Section 3.3, BHIVA guidelines (2008) – PDF download