4 ms·

> there are worrying number of HIV+ men that have stopped disclosing their status to sexual partners because they've heard that "undetectable = untransmissible.

> 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
        What you quoted does not support your point. “have a low risk of subsequent virological failure" Low risk is not zero risk. Also the actual population of people who durably achieved undetectability is effectively a true Scotsman argument in that you reject people who seemed to achieve it who then became detectable again. We don’t have long term data saying all people who are undetectable for N years are undetectable for 40 years because the treatments aren’t that old. All we can do is extrapolate and people who are undetectable for even 4 years have become detectable. Newer treatments look promising but they have even less long term data to extrapolate from. And of course things look even worse when people stop taking treatment for various reasons.
        elil17 4y ago
        Durable viral undetectability means someone has remained undetectable across all viral load measurements for 12 continuous months. So, no, it’s not a “no true Scotsman argument.” This is a scientific term with a specific definition.
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]

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
      What you quoted does not support your point. “have a low risk of subsequent virological failure" Low risk is not zero risk. Also the actual population of people who durably achieved undetectability is effectively a true Scotsman argument in that you reject people who seemed to achieve it who then became detectable again. We don’t have long term data saying all people who are undetectable for N years are undetectable for 40 years because the treatments aren’t that old. All we can do is extrapolate and people who are undetectable for even 4 years have become detectable. Newer treatments look promising but they have even less long term data to extrapolate from. And of course things look even worse when people stop taking treatment for various reasons.
      - elil17 4y ago
        Durable viral undetectability means someone has remained undetectable across all viral load measurements for 12 continuous months. So, no, it’s not a “no true Scotsman argument.” This is a scientific term with a specific definition.

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]