‘Unprotected sex OK for some with HIV’

 GENEVA: Swiss AIDS experts said on Thursday that some people with HIV who are on stable treatment can safely have unprotected sex with non-infected partners.

From Times of India

 The Swiss National AIDS Commission said patients who meet strict conditions, including successful antiretroviral treatment to suppress the virus and who do not have any other sexually transmitted diseases, do not pose a danger to others.

The proposal, published this week in the Bulletin of Swiss Medicine, astonished leading AIDS researchers in Europe and North America who have long argued that safe sex with a condom is the single most effective way of preventing the spread of the disease — apart from abstinence.

“Not only is (the Swiss proposal) dangerous, it’s misleading and it is not considering the implications of the biological facts involved with HIV transmission,” said Jay Levy, director of the Laboratory for Tumor and AIDS Virus Research at the University of California in San Francisco.

The Swiss scientists took as their starting point a 1999 study by the US Centers for Disease Control and Prevention, which showed that transmission depends strongly on the viral load in the blood. The Swiss said other studies had also found that patients on regular anti-AIDS treatment did not pass on the virus, and that HIV could not be detected in their genital fluids.

“The most compelling evidence is the absence of any documented transmission from a patient on antiretroviral therapy,” said Pietro Vernazza, head of infectious diseases at the cantonal hospital of St Gallen in eastern Switzerland and one of the authors of the report.

“Let’s be clear, the decision has to remain with the HIV-negative partner,” he said.

The studies cited by the Swiss commission did not themselves definitively conclude whether people with HIV and on antiretroviral treatment could safely have unprotected sex without passing on the virus. In practice the recommendation would affect about a third of HIV patients in Switzerland, Vernazza said, but added that patients and their partners would benefit from greatly increased quality of life, such as being able to have children without fear of passing on the virus.

Levy said there was no safe way of knowing whether a patient with HIV who has no detectable virus in the blood will not transmit the virus.

More research into the links between viral load in the blood and the presence of the virus in genital fluid was needed, he said. The World Health Organization said Switzerland would be the first country in the world to try this approach.

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