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Men taking HIV treatment have undetectable viral loads in the rectum; sexually transmitted infections make no difference
Roger Pebody, 2015-04-24 07:30:00
A small study assessing the infectiousness of HIV-positive
gay men taking antiretroviral therapy has found that all study participants had
an undetectable viral load in the rectum. Men who had rectal gonhorrea or
chlamydia didn’t have detectable virus either, suggesting that concerns about
sexually transmitted infections raising the risk of HIV transmission may be
unfounded when people are taking effective HIV treatment.
The data were presented to the British HIV Association conference in Brighton yesterday.
It has long been thought that untreated sexually transmitted
infections can raise HIV viral loads. For example, the ‘Swiss
Statement’, and its British
equivalent have both advised that the protective impact
of HIV treatment on onward transmission may not apply if either partner has a
sexually transmitted infection. However the interim results of the PARTNER
study found no HIV transmissions at all from gay men taking HIV treatment although
16% of the cohort had sexually transmitted infections while in the study.
The new data specifically concern rectal viral loads and
rectal sexually transmitted infections. There
are conflicting data on how high viral loads in rectal secretions are. A detectable
rectal viral load would increase the risk of HIV transmission during anal sex
without a condom when the man living with HIV is ‘bottom’.
Researchers at Guy’s and St Thomas’ Hospitals in London
recruited 42 men who have sex with men living with HIV who were having sexual
- 21 were taking antiretroviral therapy, including seven who
had asymptomatic rectal gonorrhoea or chlamydia.
- 21 had never taken antiretroviral therapy, again including
seven who had asymptomatic rectal gonorrhoea or chlamydia.
Rectal swabs were tested for sexually transmitted
infections, HIV viral load and ten inflammatory cytokines. (It’s hypothesised
that inflammation could raise the risk of HIV transmission).
In all men taking antitetrovirals, rectal viral loads were
undetectable (below 100 copies). This included the seven men with rectal gonorrhoea
or chlamydia, both before and after antibiotic treatment.
In men who hadn’t used antiretrovirals, rectal viral loads
were a median 2 log10 lower than their plasma viral loads. Having an
STI didn’t raise rectal viral loads or markers of inflammation, which were at
similar levels to those taking antiretrovirals.
The findings suggest that gonorrhoea and
chlamydia have a minimal impact on onward HIV transmission, the researchers say.