Hi<\/p>\n
Thanks for your question and allowing us to post the answer online.<\/p>\n
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]<\/p>\n
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 I’d therefore expect the next update from BHIVA (2008 is pretty out of date) to strengthen the support of treatment as prevention.<\/p>\n
Your doctor should be happy to discuss this with you but if you have any difficulties, please let us know and we can help.<\/p>\n
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).<\/p>\n
Once your viral load is undetectable, the risk would be close to zero if your partner has good gum health etc.<\/p>\n
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.<\/p>\n
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).<\/p>\n
I don’t have data to answer the third question. There might be comparative studies online but I couldn’t find them.<\/p>\n
This is a case where you may just have to experiment and find which ones work best for you.<\/p>\n
These links to the GMFA include more information on condoms<\/a> and\u00a0where condoms are free and can be bought online<\/a>.<\/p>\n References<\/p>\n 1. Section 3.3, BHIVA guidelines (2008) – PDF download<\/a><\/p>\n