UNDETECTABLE. 20 FACTS ALL GAY MEN SHOULD KNOW.

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  • What is treatment?

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    What is treatment?

    Treatment – or Antiretroviral Therapy (ART) – is the term we use for taking HIV medication. Unlike treatment of the past, today’s treatments are far safer, assist in faster immune recovery, reduce the risk of developing HIV/AIDS related illnesses, are much easier to take – often just one pill a day – and rapidly reduce the amount of HIV in your body.

     

    Treatment improves your quality of life and general health and importantly it reduces the risk of transmitting HIV.

     

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  • Why treat early?

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    Why treat early?

    Evidence from the START study (published in 2015) shows that the most critical and effective time to begin treatment is as soon after your diagnosis as possible.

     

    The biggest reasons to start are to improve your current and future health, but also because treatment (and maintaining an undetectable viral load) takes away the risk of transmitting HIV to your sexual partners. For people not aware of their status, regular HIV testing can help you become aware that you are HIV positive more quickly after infection, which is important because during the early stages of infection your viral load is very high, meaning, without treatment, the risk of passing on HIV is greatly increased. Your doctor can explain more.

     

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  • What does undetectable mean?

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    What does undetectable mean?

    When a HIV positive person is taking treatment (or ART) the amount of HIV in their body (known as ‘viral load’) can effectively be reduced to a level that is ‘undetectable’. It is important to note that undetectable does not mean cured or free of HIV. It simply means that the treatment has stopped the virus from replicating. A person with an undetectable viral load is no risk of passing on HIV during sex. It also means HIV is not multiplying so reducing harm to your body. Also, just like you can’t tell if someone is HIV positive by looking at them, the only way to know if they have an undetectable viral load is to talk to them.

     

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  • What does the term ‘Treatment as Prevention’ mean?

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    What does the term ‘Treatment as Prevention’ mean?

    Treatment as prevention is a term that refers to the impact that treatment has on viral load, and therefore HIV transmission risk. The PARTNERS and Opposites Attract studies showed that effective and regular HIV treatment resulting in an undetectable viral load there was no transmission of HIV from the positive partner to the negative partner. In a nutshell, we can now say that effective HIV treatment is a one of the safest forms of HIV prevention.

     

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  • How effective is treatment in reducing transmission?

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    How effective is treatment in reducing transmission?

    The findings from the PARTNER study, which looked at transmission risk for gay male couples where one was HIV positive (on treatment with undetectable viral load) show that the chances of HIV transmission as essentially zero. The PARTNER results showed no linked HIV transmissions, meaning that not one HIV positive person in the study transmitted the virus to their partner.

     

    Also, the initial results from the Opposites Attract study from the Kirby Institute at UNSW, analysing HIV transmission risk among serodiscordant couples (where one is HIV negative and one is positive) suggest that HIV is not being transmitted in the context of undetectable viral load.

     

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  • How long do I need to be on treatment before my viral load becomes undetectable?

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    How long do I need to be on treatment before my viral load becomes undetectable?

    Over 90% of people on treatment will have an undetectable viral within 3 to 6 months of starting treatment, or even earlier for some. The effectiveness of treatment within that time period depends primarily on what your viral load was before you started ART, your T-cell count, general health and whether you’ve been on treatment previously.

     

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  • Does having an undetectable viral load mean that HIV absolutely cannot be transmitted?

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    Does having an undetectable viral load mean that HIV absolutely cannot be transmitted?

    Based on the current evidence, where someone adheres to their medication and maintains an undetectable viral load there is no risk of transmitting the virus. For undetectable viral load to work as a strategy to prevent transmitting HIV, it is important that treatment is adhered to and regular viral load testing is done. If doses of medication are regularly missed, this strategy may become less effective. It’s best to test regularly to know for sure.

     

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  • I’ve met a hot guy who is HIV positive and has an undetectable viral load. Do we need to use condoms?

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    I’ve met a hot guy who is HIV positive and has an undetectable viral load. Do we need to use condoms?

    It’s always important to consider using condoms with sexual partners, including casual sex partners and random hook ups. While the viral load may be undetectable, there are other things you may want to think about – the possibility of STI transmission or when the last viral load test was. Even though the new research is saying that having an undetectable viral load is good for health and greatly reduces the risk of passing on HIV, the key to good sexual health in your relationships remains talking, choosing a prevention method that is right for you and testing.

     

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  • What if my partner and I are both positive and undetectable? Can we have sex without condoms?

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    What if my partner and I are both positive and undetectable? Can we have sex without condoms?

    If you are both positive with undetectable viral loads and want to stop using condoms, the research indicates that the risk of picking up another strain of the virus is incredibly rare, although you will need to consider the risk of contracting other STIS so you may want to have sexual health tests more regularly.

     

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  • Does having an STI impact on viral load?

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    Does having an STI impact on viral load?

    It depends on whether you are on treatment or not. If you aren’t treating HIV, then yes, becoming infected with an STI can cause an increase in viral load. For example, having syphilis can cause a big increase in the viral load, making it more likely for you to pass on the virus. That’s why it is important to get regular sexual health check-ups and to get your viral load tested after you have had an infection. However, for people who are currently on HIV treatment, STIs appear to have no or very little impact on viral load.

     

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  • If my viral load is undetectable, can I stop taking my meds?

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    If my viral load is undetectable, can I stop taking my meds?

    No. Remaining on regular treatment is the key to staying undetectable and stopping the virus from replicating (making more copies of itself) inside your body. If you stop taking your meds, then HIV will resume its impact on your immune system, your health may deteriorate and your risk of passing on HIV dramatically increases.

     

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  • Once the viral load is undetectable, does it stay that way forever?

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    Once the viral load is undetectable, does it stay that way forever?

    No. Viral load can fluctuate – small “blips” can occur, but are rare. Regular viral load monitoring is recommended because even if you always remember to take your meds, other health issues may have an impact. Even when these blips occur, they tend to be at very low level and typically don’t have an impact on your health or the risk of passing on HIV. Check with your doctor to see if the blip is significant to your health or the risk of onwards transmission.

     

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  • How often should I have my viral load tested?

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    How often should I have my viral load tested?

    This depends on your circumstances. A basic guide is every three to four months. It is best to speak with your doctor about this in more detail, depending on your personal circumstances.

     

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  • Is it possible to become undetectable if I am not on HIV meds?

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    Is it possible to become undetectable if I am not on HIV meds?

    Only about 1 in 300 people with HIV keep their viral load suppressed without taking medications. These individuals are sometimes referred to as “elite controllers”. Most people have to take HIV meds to control the virus and become undetectable.

     

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  • If I do start treatment and can’t tolerate it can I stop?

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    If I do start treatment and can’t tolerate it can I stop?

    There are a range of alternative treatment options for you, so if you find this is the case, talk to your doctor as soon as possible before you make the decision to stop, as there will be different treatment option that you can try.

     

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  • Should I be worried about the toxicity levels found in treatment?

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    Should I be worried about the toxicity levels found in treatment?

    Today’s treatments have far less side effects than treatment of previous years. We now have evidence that show that the benefits of treatment outweigh concerns around the negative impacts of these medications, especially if your CD4 counts are low. You should raise this topic with your doctor if you have any concerns about side effects.

     

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  • Can I still enjoy a drink while taking treatment?

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    Can I still enjoy a drink while taking treatment?

    Yes you can. Unlike some medications, alcohol and HIV treatment do not impact negatively when taken together.

     

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  • Do party drugs react negatively with treatment?

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    Do party drugs react negatively with treatment?

    Partying frequently, or for long periods, can make sticking to HIV treatment more complicated and make you miss treatment doses. If you do party, it is important to plan ahead so that you continue to take your HIV treatment, even if you’re having a longer session.

     

    Some treatments make the effect of recreational drugs like ecstasy and crystal meth stronger than they would be normally. If you are going to use, talk to your doctor or a healthcare professional first about their interactions; taking smaller amounts first to gauge the strength is advisable.

     

    This website gives detailed information about which HIV medications interfere with different recreational drugs: www.hiv-druginteractions.org
     
    If you feel that your alcohol or drug use is a problem, there are good services available that can help you make decisions about what to do. If you want to speak to someone about alcohol and drug use in conjunction with your HIV treatments, information is available from the alcohol and other drugs contacts here

     

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  • What if I can’t get to undetectable?

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    What if I can’t get to undetectable?

    Not all people will reach the threshold of undetectable on particular treatments, although in most cases the virus will still be suppressed to very low levels which would still represent a greatly reduced risk of transmission compared to not being on treatment. The most important thing is your own treatment is beneficial to your health, and you may want to consult your doctor to discuss your treatment goals.

     

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  • Do I still have to disclose my HIV positive status even if my viral load is undetectable?

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    Do I still have to disclose my HIV positive status even if my viral load is undetectable?

    The NSW Public Health Act 2010 requires people with HIV to disclose their status to partners before sex, regardless of whether steps are being used to prevent transmission. The Act does contain a defence of ‘reasonable precautions’. While the definition of this has not been tested in court, it is likely to be interpreted as the use of condoms. It is not clear whether undetectable viral load would be considered in this context.

     

    The NSW Public Health Act has just undergone a review with a recommendation of removing the disclosure provision and replacing it with a statement of principles concerning mutual responsibility for preventing transmission. If this recommendation is enacted by Parliament we will update this information.

     

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  • What’s the difference between treatment, PrEP and PEP?

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    What’s the difference between treatment, PrEP and PEP?

    PrEP (Pre exposure prophylaxis) is a course of HIV medication that HIV negative men might choose to take to help reduce the risk of contracting HIV. In NSW PrEP is only available as part of clinical trials or through personal importation from overseas suppliers.

     

    PEP (Post exposure prophylaxis) is a 4 weeks course of HIV medication which, if started within 72 hours after a risk event, is believed to significantly reduce the chances of becoming infected with HIV.

     

    If you are worried you or your partner has been exposed to HIV, call 1800 PEP NOW or 1800 737 669 in NSW to find out if you’re eligible for PEP and where you can get it.

     

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