Guidance: Not Infectious

HIV Science Turns a Corner

BY TODD HEYWOOD

For the first time since the HIV epidemic began, the U.S. Centers for Disease Control and Prevention in Atlanta has announced that some people living with the virus can attain a state where they pose no risk of transmitting the disease.

On Sept. 27, National Gay Men's HIV/AIDS Awareness Day, the federal agency released a guidance -- called a dear colleague letter -- declaring persons living with HIV who take their medication as prescribed and achieve an undetectable viral load "have effectively no risk of sexually transmitting the virus to an HIV-negative partner."

Since the advent of combination antiretroviral treatment in 1996, scientists and medical professionals have been aware that the treatments can suppress the virus to an undetectable level in the blood. Undetectable, for the federal government, means less than 200 viral particles per milliliter of blood -- men have on average five to six million blood cells per mL of blood, while women have an average of four to five million blood cells per mL of blood. In Michigan, many medical providers are using a much more sensitive viral load test which measures 28 or more viral particles per mL of blood.

The standard of care for HIV now is a combination of drugs which interrupts the virus' replication cycle at various stages. Scientists discovered in the 90s that three drugs targeting three different areas of the replication cycle are necessary to disrupt the virus' reproduction cycle and prevent it from developing resistance to the drugs. As a result of that combined assault on the virus, free viral particles, which can be transmitted, are drastically reduced in the blood stream.

The decision to support the messaging that people living with HIV fulfilling their treatment as a preventative move is backed by three separate studies. Those studies followed hundreds of couples -- both gay and straight -- where one partner was HIV-positive and the other was HIV-negative. In each of those studies, not a single transmission of HIV was genetically linked to the positive partner.

Michigan health officials have been telling HIV-positive people that treatment is a form of prevention for about a year, Erica Quealy, a spokesperson for the Michigan Department of Health and Human Service said in an email. That will increase this budget year she said.

"In addition, the CDC's 2018 HIV prevention grant requires that we design HIV prevention programs around treatment as prevention and we are developing our program guidance to meet these requirements," she said.

The CDC statement was warmly greeted by HIV activists as well. In MIchigan, a 1989 law makes it a felony for a person to fail to disclose his or her HIV-positive status prior to any sexual penetration, "however slight." A 1994 Michigan Supreme Court ruling upheld that law, determining in part that sexual activity by a person living with HIV was inherently risky. The new science and directive from the CDC, however, undermines that legal thinking and gives advocates working to change the law ammunition in their fight.

"By amplifying the findings from multiple studies, that people living with HIV who have an undetectable viral load will not transmit HIV to an HIV-negative partner, we can move forward with efforts to modernize our HIV laws in states like Michigan," said State Rep. Jon Hoadley (D-Kalamazoo). He has been trying to spearhead a reform effort since elected three years ago. "Let's be the generation that ends AIDS by ensuring everyone can access treatment."

Kelly Doyle, who runs the Michigan Coalition for HIV Health and Safety, an advocacy group backing Hoadley's reform efforts echoed the lawmaker's praise.

"We know that many people living with HIV deal with fear and stigma of disclosing their status due to threats of violence, harm or concern of being shunned," she said by email. "People living with HIV use safer sex behaviors to protect their partners and being undetectable is one way they do this. This shows that changing our current HIV criminalization laws is more imperative than ever and outdated to the current science of HIV."

She's also the executive director of CARES in Kalamazoo, an AIDS Serivce Organization. She said while many of the groups' clients greet the news with enthusiasm, it takes time to get them over the perception that they can become uninfectious.

"I think that most people have a hard time believing in the science and overcoming their fear infecting others," she said.


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