Question

Risks from oral sex with undetectable viral load?

6 July 2016. Related: All topics, CD4 and viral load, HIV transmission.

I have HIV and I’m on treatment for almost a year, my blood tests show an undetectable blood viral load.

I’ve met a guy a month ago, and we hit it off straightaway, we started having sex in which I was the passive part, the anal sex was always protected, but oral, in either way, was not, but we never ejaculate in each other’s mouth. And we were involved in very deep kissing, with loads of saliva swap, but I’m still anxious if my partner might have caught the virus from me.

What’s the risk for him?

Answer

Answer: Simon Collins

Hi – thanks for your question.

Ths short answer is that this risk is zero when viral load is undetectable.

One of the important bits of information that you included, is that you have been on treatment with an undetectable for the last year or so. This may be reducing any risk as much as the different type of sex you have.

HIV is not infectious in saliva, which makes kissing safe, even deep kissing.

By using a condom when you have anal sex, you are cutting out the highest risk factor.

Most cases of HIV transmission from oral sex are probably explained by two factors. The HIV-positive partner having extremely high viral load (often in the millions during the first weeks of infection), or often over 10,000 copies/mL when not on treatment.The second factor is oral hygiene and/or dental problems in the HIV-negative partner.

Otherwise, oral sex is very low risk, if your partners mouth is in good shape, especially as your viral load is so low. It is important that your partner doesn’t have bleeding gums or ulcers, or brushes his teeth just before. It is probably still better not to come in your partners mouth but if you did it is very unlikely to make much difference to the risk of HIV.

A group of Swiss experts recently estimated the risk from one exposure from an HIV-positive man to an HIV-negative woman – for example from a broken condom – to be perhaps 1 in 100,000 – so long as the man had undetectable viral load for the last six months, was taking his HIV meds on time, and had no sexual infections.

I see the most useful interpretation of this, to be to continue to use condoms, but not to worry too much if one breaks occasionally. For oral sex, which is already a much lower risk than not using a condom for anal sex, I think this is getting pretty close to zero.

More recently, other studies, including the PARTNER study, have reported that wehn viral load is undetectable, the risk from sex is likely to be zero. This is for any type of sex, even when condoms are nt used.

If the risk is zero for fucking without a condom, it is definitely zero for oral sex.

Note: This answer was updated in July 2016 from a question first posted in May 2008. The update was to include results from the PARTNER study that report zero HIV transmissions when an HIV positive partner has an undetectable viral load.