Question

Can I have unprotected sex with my partner?

27 March 2009. Related: All topics, CD4 and viral load, HIV reinfection (superinfection), HIV transmission, Resistance.

Undetectable viral load means that the tests that are used to check for the amount of virus in the blood cannot detect any virus. Different lab tests have a cut-off, below which they cannot detect the virus. Years ago the cut-off was 10,000, then 500, then 400, and now it is routinely 50 or 40, depending on the test. Some researchers, use tests that can detect even 1-2 copies of the virus in the sample. Those assays are not a part of the routine clinical practice.

The major goal of the ARVs is to reduce the VL to undetectable, as then we know that the virus is well suppressed. At levels below 50, the virus is not evolving and developing. You are only taking ARVs then to catch new virus that wkes from resting CD4 cells. This is why adherence is important, as the pressure on the virus needs to be constant, with mimimum durgs levels through the day and night.. If you want to know more about the VL, reinfection and these aspects, you can click here.

As for having unprotected sex, there are several conditions that you may decide to discuss with your partner before you make your mind about it. Having an undetectable viral load makes it much less likely to pass on HIV, whether as a new infection or reinfection.
Some recent reports showed possibilities of infection even if the person has an undetectable viral load but reinfection is very unlikely.

Also, if you and your partner have the same resistance pattern (you should both already have results from a genotype resistance test in your notes), then there is no risk to you.
This only risk then are from infections that you could catch outside your main relationship, which means still using condoms if you have other sexual partners.,

Your partner will need to be adherent to treatment by not missing doses (so that he/she does not become resistant to the current therapy and risk passing that resistance to you).
Although this sound complicated, it should be fine if you decide to have unprotected sex And many couples find this one aspect of being HIV-positive that affects their quality of life in a very good way.

Some people actively chose HIV-positive partners because this aspect of life is so important to them, and they can enjoy sex in a way that removes the risk of exposing their partner to HIV.

Answer

Answer: Simon Collins