The British HIV Association (BHIVA) and the Expert Advisory Group on AIDS (EAGA) recently issued a position statement on the use of antiretroviral therapy (ART) by HIV positive individuals to reduce HIV transmission.
The statement cites the HPTN 052 trial -- that showed 96% reduction in transmission of HIV through vaginal sex -- and notes that successful ART use by the HIV positive person is as effective as consistent condom use in limiting transmission.
It stresses that this is provided the following conditions are fulfilled: absence of other STIs in both partners; the HIV positive person has sustained viral suppression below 50 copies/mL for over 6 months and regular viral load testing (3-4 monthly) is performed.
Published data are largely from heterosexual couples and there is insufficient evidence to conclude that ART offers similar levels of protection with other sexual practices -- including unprotected anal intercourse (whether heterosexual or gay/MSM). The statement gives expert opinion that an "extremely low risk" of transmission can be anticipated where the conditions described above are met.
Health care professionals are recommended to discuss the impact of ART on transmission with HIV positive people as well as the possibility of starting ART for this purpose.
Fidler S et al. Position statement on the use of antiretroviral therapy to reduce HIV transmission January 2013. The British HIV Association (BHIVA) and the Expert Advisory Group on AIDS (EAGA).
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