8 ms·

>> I think it's quite likely that at least one of these 5 people have... something in their body that could be transfected into another person's cells and cause

by elil17 4y ago

>> I think it's quite likely that at least one of these 5 people have... something in their body that could be transfected into another person's cells and cause an active HIV infection. No, they definitely don't. It's well known[1] that people without detectable levels of HIV in their blood cannot transmit HIV to other people. That is true for people who are simply receiving normal treatments (see: https://www.nih.gov/news-events/news-releases/science-clear-hiv-undetectable-equals-untransmittable https://www.nih.gov/news-events/news-releases/science-clear-...). It is certainly also true for these transplant recipients. Edit: [1]: Specifically, researchers have never observed transmission from someone with undetectable viral load, despite many large studies searching for such an event

nostromo 4y ago
What you've said is true, but I'd add that there are worrying number of HIV+ men that have stopped disclosing their status to sexual partners because they've heard that "undetectable = untransmissible." While that does seem to be true, there are a number of problems with this: 1. Not everyone takes their medications exactly as prescribed. 2. Lots of folks on antiretroviral therapy are not undetectable, or may move between undetectable and detectable over time. It's important that people still disclose their status to sex partners.
- School-Cotton 4y ago
  > there are worrying number of HIV+ men that have stopped disclosing their status to sexual partners because they've heard that "undetectable = untransmissible." I thought that was the entire point of the “undetectable = untransmissible” campaign — freeing people from worrying about passing it to others and having to live with a scarlet letter, which is an incentive to get treated > It’s important that people still disclose their status Why?
  - Retric 4y ago
    Because having undetectable levels on day 1 doesn’t mean you have undetectable levels on day X and people don’t test every single day. Further, if you’re in a long term relationship for years and your status changes you don’t want to suddenly have a big secret come out.
    - jjtheblunt 4y ago
      This is a perfect counterexample for the flawed logic of the argument put forth by another commenter above, which appears in marketing materials for drug companies in American media, frighteningly.
    - chimeracoder 4y ago
      > Because having undetectable levels on day 1 doesn’t mean you have undetectable levels on day X and people don’t test every single day. This is both clinically wrong and a red herring. Once a person has durably achieved clinical undetectability under HAART, they do remain undetectable.
      - Retric 4y ago
        > they do remain undetectable False. https://pubmed.ncbi.nlm.nih.gov/19043927/ https://pubmed.ncbi.nlm.nih.gov/19043927/ In the first year after achieving VL undetectability, 354/1386 (25.5%) patients experienced low-level VL rebound, the remaining patients maintained consistent undetectability. Low-level rebound occurred less commonly with non-nucleoside reverse transcriptase inhibitor (NNRTI)-based HAART than with other regimens (P = 0.01). Over median 2.2 (range 0.0-7.4) years of subsequent follow-up, 86 (6.2%) patients experienced virological failure, corresponding to 2.30 failures per 100 person-years (95% confidence interval [CI] 1.82-2.79). Independent predictors of virological failure included low-level rebound during the first year after achieving undetectability relative to consistent undetectability (rate ratio [RR] 2.18, 95%0 CI 1.15-4.10), female gender (RR 1.79, 95% CI 1.12-2.85) and receiving a ritonavir-boosted protease inhibitor (Pl/r) relative to NNRTI-based HAART (RR 1.88, 95% CI 1.02-3.46).
        chimeracoder 4y ago
        > False. https://pubmed.ncbi.nlm.nih.gov/19043927/ https://pubmed.ncbi.nlm.nih.gov/19043927/ > In the first year after achieving VL undetectability... I'm gathering from your comments that you don't have a clinical background in HIV research (because if you did, you would not be posting this as a reply). Not only does your link not prove what you think it does, but it actually says the exact opposite: once a patient has durably achieved clinical undetectability under HAART, they do remain undetectable, even when using older generations of drugs that are no longer first-line treatments. It even states that in the conclusion: " Patients on first-line HAART who maintain consistent VL undetectability for 1 year have a low risk of subsequent virological failure." To spell it out: the mistake you're making is that you're looking at a paper that studies treatment-naive patients and whether or not they durably achieve undetectability, whereas what we're talking about is patients who have already durably achieved undetectability. So the paper you linked isn't particularly relevant to our conversation, because it's studying a completely unrelated endpoint, but by coincidence, it does actually corroborate the point I was making.
  - nostromo 4y ago
    Nobody is saying you should live with a scarlet letter. But you should disclose to people you're having sex with your status and let them make an informed decision. It's worrying that this is even controversial.
    - ralusek 4y ago
      What's more worrying is that this is controversial even in cases where people are not being treated at all. Efforts to criminalize knowingly infecting someone with HIV without their consent are very often shut down as homophobic/racist/etc.
      - emiliobumachar 4y ago
        The problem with such criminalization is that it disincentivizes getting tested.
        thaumasiotes 4y ago
        The fix for that would be to take out the 'knowingly' requirement.
        nostromo 4y ago
        That was an issue before treatment was available. But now not dying is a very strong incentive to still get tested.
        est31 4y ago
        Untreated HIV (usually) takes years to cause AIDS, and then takes months to years for you to die from it. Before you have AIDS, you can still start treatment, and can still enjoy a long life afterwards. That being said though, the earlier you start treatment, the better. So yes, there are still strong incentives to get tested, but people still don't get tested when having HIV is criminalized.
      - deleted 4y ago
        [deleted]
- chimeracoder 4y ago
  A lot of misconceptions in this and other comments. To address the two most glaring ones: > 1. Not everyone takes their medications exactly as prescribed. That's irrelevant. Not only is there a fair amount of leeway in the standard dosing schedules (meaning that missing some doses does not actually cause a clinically meaningful impact), but the studies that demonstrate that U=U are based on real-world applications. Variability from adherence is already captured by the results. > 2. Lots of folks on antiretroviral therapy are not undetectable, or may move between undetectable and detectable over time. This is not true and based on an incorrect understanding of what "undetectable" signifies clinically. Once a person has durably achieved clinical undetectability under HAART, they do remain undetectable, as long as there is no prolonged disruption in treatment[0]. The most common reason for a disruption in treatment is an inability to access treatment - not something that happens without the person's full awareness. People on Internet forums like HN like to get worked up about bogeymen like people intentionally not taking their medications, but actual clinical data shows that stuff is largely the realm of urban legends, not reality. And if you're that concerned about it, the answer is simple: PrEP prevents HIV with a near-100% efficacy, rendering the question "is this person undetectable?" moot. [0] Emphasis on prolonged. Missing a few days, or even a week or two, does not cause HIV to become detectable again. These sorts of treatment interruptions are contraindicated, but for other unrelated clinical reasons, not because of the impact on viral load.
  - nostromo 4y ago
    > as long as there is no prolonged disruption in treatment Which happens all the time. Treatment is significantly more burdensome and expensive than women taking birth control, for example, and we all know how accidents still happen. Notice how you’re shifting the blame to the victim, who was knowingly put at risk. “It’s really your fault because you’re not on Prep.” It’s just bizarre how worked up people get about not wanting to be honest with their sex partners. It’s basic human decency.
    - SamoyedFurFluff 4y ago
      Birth control has way less leeway than the parent describes hiv treatment. Oral birth control fluctuates wildly and must be taken literally within the same hour or so every day. I don’t think birth control and hiv transmissibility are comparable cases here, because the potential for pregnancy and the potential for hiv infection don’t appear to work remotely similarly. I don’t personally have a horse in this race, I’m merely pointing out I think this comes off as not understanding pregnancy prevention, hiv treatment, or both.
Vecr 4y ago
I'm not saying they could transmit though sex, I'm saying they could be caused to transmit through what is essentially viral cloning, by taking either a cell (or probably many cells, because the recipient has an immune system) containing proviral DNA (i.e. the DNA created by HIV's reverse transcription mechanism), and putting it into the recipient, or by taking the HIV proviral DNA from that cell and transfecting cells of the recipient with it, similar to how you can clone a polio virus by transfecting a cell with the DNA of polio, even though polio is an RNA virus. This has been done by Vincent Racaniello using early DNA sequencing techniques, and could be tested in an animal because of the Gain of Function'd mouse model he made. I can't remember anyone being able to create an animal model for HIV though...
- elil17 4y ago
  Well in that case I hope no one is out there transplanting cells from these people into other people. I can’t imagine why anyone would do that. It seems to me like this should still count as curing someone.
  - Vecr 4y ago
    Well, I think being precise in virology is a good thing. For example being infected with SARS-CoV-2 and having the disease COVID-19 are not exactly the same thing, and matter quite a bit when writing a prescription for Paxlovid. You can't (or aren't supposed to) write off-label prescriptions for EUA drugs, so it does matter. Apparently they changed the EUA recently though, and Internet rules lawyers think they can prescribe it to people who don't have COVID-19 at all, so it might not matter at this point.
jjtheblunt 4y ago
A lack of an example absolutely has never constituted a proof that no example can exist, without further information. This is a fundamental tenet of science and in particular of the discrepancy between constructive and non constructive proofs in mathematics.
- elil17 4y ago
  I guess there’s a difference between a mathematical proof and practical, real life truth. Multiple studies have looked for transmission across tens of thousands of unprotected penetrative sex acts. There’s also a solid theoretical backing to the concept - it lines up with how we think HIV transmission works. So it’s a bit like saying maybe there’s Bigfoot out there. Sure, maybe, but we have a pretty good reason to think there isn’t. For practical purposes no one should assume big foot is out there.

by elil17 4y ago

nostromo 4y ago

What you've said is true, but I'd add that there are worrying number of HIV+ men that have stopped disclosing their status to sexual partners because they've heard that "undetectable = untransmissible." While that does seem to be true, there are a number of problems with this: 1. Not everyone takes their medications exactly as prescribed. 2. Lots of folks on antiretroviral therapy are not undetectable, or may move between undetectable and detectable over time. It's important that people still disclose their status to sex partners.

School-Cotton 4y ago
> there are worrying number of HIV+ men that have stopped disclosing their status to sexual partners because they've heard that "undetectable = untransmissible." I thought that was the entire point of the “undetectable = untransmissible” campaign — freeing people from worrying about passing it to others and having to live with a scarlet letter, which is an incentive to get treated > It’s important that people still disclose their status Why?
- Retric 4y ago
  Because having undetectable levels on day 1 doesn’t mean you have undetectable levels on day X and people don’t test every single day. Further, if you’re in a long term relationship for years and your status changes you don’t want to suddenly have a big secret come out.
  - jjtheblunt 4y ago
    This is a perfect counterexample for the flawed logic of the argument put forth by another commenter above, which appears in marketing materials for drug companies in American media, frighteningly.
  - chimeracoder 4y ago
    > Because having undetectable levels on day 1 doesn’t mean you have undetectable levels on day X and people don’t test every single day. This is both clinically wrong and a red herring. Once a person has durably achieved clinical undetectability under HAART, they do remain undetectable.
    - Retric 4y ago
      > they do remain undetectable False. https://pubmed.ncbi.nlm.nih.gov/19043927/ https://pubmed.ncbi.nlm.nih.gov/19043927/ In the first year after achieving VL undetectability, 354/1386 (25.5%) patients experienced low-level VL rebound, the remaining patients maintained consistent undetectability. Low-level rebound occurred less commonly with non-nucleoside reverse transcriptase inhibitor (NNRTI)-based HAART than with other regimens (P = 0.01). Over median 2.2 (range 0.0-7.4) years of subsequent follow-up, 86 (6.2%) patients experienced virological failure, corresponding to 2.30 failures per 100 person-years (95% confidence interval [CI] 1.82-2.79). Independent predictors of virological failure included low-level rebound during the first year after achieving undetectability relative to consistent undetectability (rate ratio [RR] 2.18, 95%0 CI 1.15-4.10), female gender (RR 1.79, 95% CI 1.12-2.85) and receiving a ritonavir-boosted protease inhibitor (Pl/r) relative to NNRTI-based HAART (RR 1.88, 95% CI 1.02-3.46).
      - chimeracoder 4y ago
        > False. https://pubmed.ncbi.nlm.nih.gov/19043927/ https://pubmed.ncbi.nlm.nih.gov/19043927/ > In the first year after achieving VL undetectability... I'm gathering from your comments that you don't have a clinical background in HIV research (because if you did, you would not be posting this as a reply). Not only does your link not prove what you think it does, but it actually says the exact opposite: once a patient has durably achieved clinical undetectability under HAART, they do remain undetectable, even when using older generations of drugs that are no longer first-line treatments. It even states that in the conclusion: " Patients on first-line HAART who maintain consistent VL undetectability for 1 year have a low risk of subsequent virological failure." To spell it out: the mistake you're making is that you're looking at a paper that studies treatment-naive patients and whether or not they durably achieve undetectability, whereas what we're talking about is patients who have already durably achieved undetectability. So the paper you linked isn't particularly relevant to our conversation, because it's studying a completely unrelated endpoint, but by coincidence, it does actually corroborate the point I was making.
- nostromo 4y ago
  Nobody is saying you should live with a scarlet letter. But you should disclose to people you're having sex with your status and let them make an informed decision. It's worrying that this is even controversial.
  - ralusek 4y ago
    What's more worrying is that this is controversial even in cases where people are not being treated at all. Efforts to criminalize knowingly infecting someone with HIV without their consent are very often shut down as homophobic/racist/etc.
    - emiliobumachar 4y ago
      The problem with such criminalization is that it disincentivizes getting tested.
      - thaumasiotes 4y ago
        The fix for that would be to take out the 'knowingly' requirement.
      - nostromo 4y ago
        That was an issue before treatment was available. But now not dying is a very strong incentive to still get tested.
        est31 4y ago
        Untreated HIV (usually) takes years to cause AIDS, and then takes months to years for you to die from it. Before you have AIDS, you can still start treatment, and can still enjoy a long life afterwards. That being said though, the earlier you start treatment, the better. So yes, there are still strong incentives to get tested, but people still don't get tested when having HIV is criminalized.
    - deleted 4y ago
      [deleted]
chimeracoder 4y ago
A lot of misconceptions in this and other comments. To address the two most glaring ones: > 1. Not everyone takes their medications exactly as prescribed. That's irrelevant. Not only is there a fair amount of leeway in the standard dosing schedules (meaning that missing some doses does not actually cause a clinically meaningful impact), but the studies that demonstrate that U=U are based on real-world applications. Variability from adherence is already captured by the results. > 2. Lots of folks on antiretroviral therapy are not undetectable, or may move between undetectable and detectable over time. This is not true and based on an incorrect understanding of what "undetectable" signifies clinically. Once a person has durably achieved clinical undetectability under HAART, they do remain undetectable, as long as there is no prolonged disruption in treatment[0]. The most common reason for a disruption in treatment is an inability to access treatment - not something that happens without the person's full awareness. People on Internet forums like HN like to get worked up about bogeymen like people intentionally not taking their medications, but actual clinical data shows that stuff is largely the realm of urban legends, not reality. And if you're that concerned about it, the answer is simple: PrEP prevents HIV with a near-100% efficacy, rendering the question "is this person undetectable?" moot. [0] Emphasis on prolonged. Missing a few days, or even a week or two, does not cause HIV to become detectable again. These sorts of treatment interruptions are contraindicated, but for other unrelated clinical reasons, not because of the impact on viral load.
- nostromo 4y ago
  > as long as there is no prolonged disruption in treatment Which happens all the time. Treatment is significantly more burdensome and expensive than women taking birth control, for example, and we all know how accidents still happen. Notice how you’re shifting the blame to the victim, who was knowingly put at risk. “It’s really your fault because you’re not on Prep.” It’s just bizarre how worked up people get about not wanting to be honest with their sex partners. It’s basic human decency.
  - SamoyedFurFluff 4y ago
    Birth control has way less leeway than the parent describes hiv treatment. Oral birth control fluctuates wildly and must be taken literally within the same hour or so every day. I don’t think birth control and hiv transmissibility are comparable cases here, because the potential for pregnancy and the potential for hiv infection don’t appear to work remotely similarly. I don’t personally have a horse in this race, I’m merely pointing out I think this comes off as not understanding pregnancy prevention, hiv treatment, or both.

Vecr 4y ago

I'm not saying they could transmit though sex, I'm saying they could be caused to transmit through what is essentially viral cloning, by taking either a cell (or probably many cells, because the recipient has an immune system) containing proviral DNA (i.e. the DNA created by HIV's reverse transcription mechanism), and putting it into the recipient, or by taking the HIV proviral DNA from that cell and transfecting cells of the recipient with it, similar to how you can clone a polio virus by transfecting a cell with the DNA of polio, even though polio is an RNA virus. This has been done by Vincent Racaniello using early DNA sequencing techniques, and could be tested in an animal because of the Gain of Function'd mouse model he made. I can't remember anyone being able to create an animal model for HIV though...

elil17 4y ago
Well in that case I hope no one is out there transplanting cells from these people into other people. I can’t imagine why anyone would do that. It seems to me like this should still count as curing someone.
- Vecr 4y ago
  Well, I think being precise in virology is a good thing. For example being infected with SARS-CoV-2 and having the disease COVID-19 are not exactly the same thing, and matter quite a bit when writing a prescription for Paxlovid. You can't (or aren't supposed to) write off-label prescriptions for EUA drugs, so it does matter. Apparently they changed the EUA recently though, and Internet rules lawyers think they can prescribe it to people who don't have COVID-19 at all, so it might not matter at this point.

jjtheblunt 4y ago

A lack of an example absolutely has never constituted a proof that no example can exist, without further information. This is a fundamental tenet of science and in particular of the discrepancy between constructive and non constructive proofs in mathematics.

elil17 4y ago
I guess there’s a difference between a mathematical proof and practical, real life truth. Multiple studies have looked for transmission across tens of thousands of unprotected penetrative sex acts. There’s also a solid theoretical backing to the concept - it lines up with how we think HIV transmission works. So it’s a bit like saying maybe there’s Bigfoot out there. Sure, maybe, but we have a pretty good reason to think there isn’t. For practical purposes no one should assume big foot is out there.