Medical HIV Suppression Is Well Within Reach

More evidence that the treatment for HIV infection also stops its spread.


A new study published today in The Lancet shows that the medical therapy currently used to treat HIV is capable of preventing people from spreading it through sexual activity, even when they're not using condoms.

The theory is far from new, and this isn't the first study to show that HIV can be suppressed enough so that those who are infected can't pass the virus along to others. But it nevertheless is an important development. Advances in medicine and science are turning a once-deadly public health nightmare into something that can be managed.

This study involved more than 700 gay couples spread across 14 European countries where one partner was HIV positive and one was negative. The HIV-positive partner was taking regular drug therapy to suppress the levels of the virus in his body. Across seven years, these couples documented more than 76,000 instances of condomless anal sex.

In exactly zero cases—none at all—did the HIV-positive man infect his partner. There were 15 new HIV infections among those participating in the study, but researchers were able to determine that these new infections did not originate from the HIV-positive partners. (Thirty-seven percent of the HIV-negative participants acknowledged having condomless sex with others besides their partner.)

These results come on the heels of a similar study that included a mix of heterosexual and same-sex couples. There too, there were no transmissions of HIV from an infected partner if that partner was on drug therapy that effectively suppressed the virus. And before that, a pivotal study in 2015, this one focused primarily on heterosexual couples, found only four transmissions of HIV between an infected person and his or her partner.

All of that is to say that at this point, the news from today's study shouldn't come as a surprise. (Indeed, the outcome was previewed a year ago—today is the formal publication of the study.) It's another piece of evidence that HIV treatment doubles as HIV prevention, heralding a very important shift in the approach to managing the public health risks. The "undetectable=untransmittable" concept, shorthanded as "U=U," is relatively young campaign launched in 2016 to try to help explain that medical suppression of HIV so that its viral levels don't show up in blood tests means that it cannot be transmitted to other people. The hope here is to encourage more people to get tested and seek treatment.

In the United States, we're seeing about 38,000 new HIV infections per year, and about 15 percent of people who are infected do not even know it. Furthermore, only about half of the people with HIV in the United States have been receiving enough medical treatment to reduce the virus to the point that it would be considered "undetectable."

In his State of the Union Address in February, President Donald Trump said he wanted to eliminate the HIV epidemic in America in 10 years. It seems unlikely that it can be shut down entirely, but it is possible to get it suppressed to the point that new infections are very rare. These studies should be seen as evidence that we already have the solution to stop the spread of HIV. It's now a logistical matter to figure out the best ways to make sure that the treatment is accessible and that people are aware it's out there.

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  1. >>>These studies should be seen as evidence that we already have the solution to stop the spread of HIV.

    great! watched my uncle and everyone he was friends with die 30 years ago it sucked. don’t want that for anyone.

    1. I agree and don’t mean to rain on your parade.

      But I’m a sour-puss old grump, and worry about unintended consequences. We added anti-skid brakes and airbags and who-knows-what-all to car stabilization techniques to improve handling on taking fast and tight corners. We should ALL be safer now, right!?! No! Because asshole drivers now feel ALL that much more safe, so they drive THAT much more like assholes!!! And safety never improves NEARLY as much as we expect, because… Assholes will be assholes!!!

      Similarly, the safer we feel about AIDs, the more we will “drive like assholes”… Drive our peckers, in this case. Take risks (on the socialized dollar of medical care, no less) and report late, fix late, dance with death… SOMEONE ELSE (think taxpayer) will rescue me from my own stupid, at the last minute! And the more that “med tech” can pull our fat (and our peckers) out of the fire, at THE last nanosecond, the more that we will test the limits!

      1. Sounds like a good time.

      2. not certain prudence is innate.

      3. The death rate per vehicle miles travelled has still fallen significantly since the 70s, even if we are riskier drivers.

        Overall this is a great thing for humanity. We’ve maybe not defeated HIV, but we’re heading that way after years of slow progress.

        1. Not banning enjoyable substances, thereby NOT decreasing demand for needles, and NOT butting into opium wars on the other side of the planet are libertarian platform staples. Voting LP is the best way to fight AIDS and coercive fanaticism all in one package. Pity this has taken so long to sink in.

      4. But I’m a sour-puss old grump, and worry about unintended consequences.

        Considering that the side effects of of reckless sex are never as severe as a death sentence, I’d say your concern is severely misplaced.

        And your analogy doesn’t support your point, because even if your claim that people drive more recklessly is true, it is a fact that deaths *have* gone down as we made cars safer.

        It’s nonsense to be so obsessed with the moral hazard of things people generally want to avoid naturally. Maybe the state will pay for repeated health problems, but in the meanwhile you have health problems. I tried to avoid STDs and unplanned pregnancy when I was single, but I avoided those things because I knew they would make me miserable, not because the state or someone else like my parents could pay to fix my mistakes.

        1. “Considering that the side effects of of reckless sex are never as severe as a death sentence, ”

          Actually, HIV was a demonstration that the side effects of reckless sex can, in fact, range all the way up to a death sentence.

      5. SQRLY

        The people in the study had no idea if the sex was risk free. In fact some did contract the disease from other partners and were excluded from the analysis.

        The point is that in relationships, so they started with couples and tracked them. A separate arm tracked hetero couples and found the same results. It is believed that unprotected anal sex between make homosexuals has the highest risk. That is probably true. So they took the highest risk group and tracked them.

        Truth is people do what they do. You are worried this is a green light to take more risk. It is not. It is a study demonstrating with a high degree of confidence that those people taking and complying with the drug regimen have an unexpected result. Zero transmission in this cohort even when they did the unadvisable. It is astonishing really.

        As always other studies could show different results. No medical advice should come from a single study.

  2. 0However, the scientific detection of small amounts of HIV RNA in semen does not appear to correlate with risk of HIV transmission if plasma viral load is suppressed. This finding might be because the virus present is not whole virus, is not replication competent, or is present at insufficient levels to cause transmission.21

    That is interesting. So even though the virus can be detected in semen in some percent of people on the suppressive drugs it may be that the virus has been rendered inoperable in some way.

    Seems like another thing to look into.

  3. Sadly too late for some good folks, but great that they’ve found what looks like an effective weapon against this scourge.

  4. A key point to understand here, though, is that evolution doesn’t leave niches unoccupied. We got AIDS because people engaged in the sort of behavior that created an evolutionary niche for a disease like that.

    As the scare wears off, and the behavior resumes, expect some other horrific STD to fill the hole. The sort of people who got and transmitted HIV were also getting and transmitting other STDs. They were STD disease factories, basically.

    And are becoming that again, as they lose their fear of HIV.

    1. Rampant exchange of bodily fluids will be a major cause of society’s downfall. After AlDS, there will be NRS, then there will be UBT.

  5. To mohammedans in Africa the 1980s wrestling match between the U.S. and Soviet Great Satans were an opportunity to add local monkey virus to heroin and ship it to Afghanistan for distribution to both foreign troops. U.S. bureaucracies had already banned all manner of drug, prompting the use of needles, then been surprised by outbreaks–first of hepatitis, then HIV in every city that banned clean needles. Of course God’s Own Prohibitionists have since blamed it on godless homosexurals. This is dinned from every TV and newsrag in exchange for Nixon tax subsidies for the parties that passed those laws and urged that war.

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