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Laura J Waters consultant in genitourinary/HIV medicine, Simon Collins advocate, Marta Boffito consultant and HIV service lead Waters Laura J, Collins Simon, Boffito Marta. Guidelines in the context of medical ethics BMJ 2019; 364 :l1040
Key Points Question What is the risk of HIV transmission through condomless sex from an HIV-positive person taking suppressive ART? Findings In this observational study in HIV-serodifferent heterosexual and MSM couples having ongoing condomless sex over 1238 couple-years of follow-up, there were no cases of within-couple HIV transmission (upper 95% confidence limit of 0.30/100 couple-years of follow-up).
Over the last year, hundreds of HIV organisations have joined a new campaign to endorse the statement that HIV transmission does not occur when viral load is undetectable on ART. And while the dramatic impact of ART on reducing HIV transmission has been known for a long time, it is new to say ART stops transmission completely. This change is especially important given that prejudice and discrimination against HIV positive people is still widespread.
How can the study prove that transmission didn't come from the positive partner? Research tests are able to compare different viruses from different people. This uses special laboratory testing -- called phylogenetic analysis. If the genetic structure of the new virus is very different to the partner's virus, this shows the infections are not linked. It shows that HIV came from outside the main relationship. These results were reviewed by independent experts and are an essential part of the study.
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