6 ms·

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 he

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.
        Retric 4y ago
- 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.

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.
      - Retric 4y ago
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.