A recent study suggests that condomless sex for HIV positive (human immunodeficiency virus) who are on antiretroviral therapy (ART) is safe for their HIV negative partners. As the patients take ART, they carry reduced viral load which is unlikely to infect their sex partners. Led by the scientists from University College London, this retrospective study presents significant findings for people living with HIV. This extensive research was funded by National Institute for Health Research.
Globally, 36.7 million people live with HIV while about 17 million people have access to antiretroviral therapy to fight off HIV. Although, no current medication or vaccine can fight off HIV completely, suppressive antiretroviral therapy is highly effective to contain the symptoms. The suppressive antiretroviral therapy (ART) is a combination of antiviral drugs that are prescribed to the HIV positive patients to reduce the viral titer in their system. This, in turn, has shown to help the HIV patients effectively.
In addition to having a poor health, people who suffer from HIV virus have an added baggage of responsibility to not transmit the virus to other people. Even if HIV positive people are in good health, they remain carriers of the virus for the rest of their life. The disease has an adverse effect on their lifestyle which can frequently lead to social isolation and stereotypes. To ensure health safety, HIV positive people are highly recommended to wear condoms during sexual intercourse, and not have condomless sex.
With an emphasis on them using condoms, the personal preference of the person about wearing it often becomes secondary.
However, this recently published research in the Journal of the American Medical Association (JAMA) can help men make decisions as they will, about the use of condoms.
The use of condoms has only helped protect sex partners of HIV patients. On the contrary, with the use of ART, people are not only able to protect their partners but they are also free to make decisions about their lifestyle in addition to improving their health.
The research was conducted in 14 European countries with included 888 couples, including homosexual men and heterosexual couples. All the HIV positive research participants were receiving ART and a low HIV-1 RNA load was noted in them. This viral genome load was as low as 200 copies/ml. Out of them, 340 male couples and 548 heterosexual couples were followed up for 1.3 years to observe the proposed hypothesis.
All these participants were reported to be on ART while having sex without using condoms. On an average, these couples had sex 37 times a year. Disease progression was recorded after every 6-12 months in the HIV positive patients through the measurement of plasma HIV-RNA. On the other hand, HIV tests for the HIV negative partners were also carried out after every four to six months.
Interestingly, amongst all the couples only 11 previously HIV negative people contracted the virus. Out of them, ten were gay men.
Out of these ten people, eight reported to have had condomless sex with other partners. Other might have contracted it from using unsterilized syringes or unscreened blood transfusion.
To fortify the accuracy of their findings, another set of test was performed on people who had recently contracted the virus. A venous blood sample in EDTA was taken from both the partners to see the genetic relatedness between the HIV strains.
In this context, Anna Geretti from University of Liverpool’s Institute of Infection and Global Health said that HIV virus has several subcategories. Amongst them, all types have their distinctive genetic sequence which helps determine if the virus is contracted from their partners or other persons.
From these tests, it was found that none of the 11 participants contracted the virus from their partners but from other mode of transmission. Confirming that the transmission rate was zero in condomless sex with the use of ART, this is a pioneering study that draws a comparison between the use of ART and condomless sex.
Primarily designed to record transmission rate through anal sex, other risk factors were not fully discussed in the study. A limited number of study participants failed to represent the entire target population. In additional to this, the follow up time was also not sufficient to draw a reliable conclusion.
Although this study is significant in its findings, more studies are warranted to reach a final conclusion. As HIV is the most prevalent sexually transmitted disease at a global level, large scale studies are to be conducted on ethnically and geographically diverse populations. While, people from different regions may have varied response to the drugs, the penetrance of the viral strain may also be different. These differences are significant to be considered to pass a final verdict at a global level.