4 ms·

From [5] https://www.hiv.gov/blog/science-validates-undetectable-untransmittable-hiv-prevention-message https://www.hiv.gov/blog/science-validates-undetectable-

From [5] https://www.hiv.gov/blog/science-validates-undetectable-untransmittable-hiv-prevention-message https://www.hiv.gov/blog/science-validates-undetectable-untr...: > Even when viral load is undetectable, ... may have detectable HIV genetic material in ... semen, but there is no scientific evidence that such material is associated with HIV transmission. What? Isn't that the primary transmission vector?

toomuchtodo 2y ago
From that same link you cite: > Findings from the breakthrough NIH-funded HPTN 052 clinical trial, a decade-long study involving more than 1,600 heterosexual couples, offered clear-cut evidence that ART that consistently suppresses HIV also prevents sexual transmission of the virus. In 2011, the HPTN 052 investigators reported that starting ART when the immune system is relatively healthy, as opposed to delaying therapy until the immune system has been weakened by the virus, dramatically reduces the risk of sexually transmitting HIV. The protective effect of starting ART early was sustained over four additional years of follow-up. Importantly, when viral loads were measured, no HIV transmissions were observed when ART consistently, durably suppressed the virus in the partner living with HIV. Wild speculation is that the genetic material you mention is inactivated and therefore unable to transmit the virus, but is still detectable. I am just an internet rando surfing the knowledge graph, but the science appears sound. https://www.nih.gov/news-events/news-releases/hiv-control-through-treatment-durably-prevents-heterosexual-transmission-virus https://www.nih.gov/news-events/news-releases/hiv-control-th... https://web.archive.org/web/20150106032855/http://www.niaid.nih.gov/news/newsreleases/Archive/2011/Pages/HPTN052Breakthrough.aspx https://web.archive.org/web/20150106032855/http://www.niaid.... https://www.clinicaltrials.gov/study/NCT00074581 https://www.clinicaltrials.gov/study/NCT00074581
- pstrateman 2y ago
  >1,600 heterosexual couples Is there a similar study of gay men who are not in a monogamous relationship? Studying the group with the lowest transmission rate who could still transmit seems kind of dishonest.
  - foldr 2y ago
    It's not 'dishonest'. It's important data for parts of the world where heterosexual transmission of the virus is common. And yes, there is a similar study: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30418-0/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
deleted 2y ago
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Vecr 2y ago
I don't buy U=U, I've not seen a proper impossibility proof re. provirus mutation. There's probably infections drowned out against the background rate.
- 4fterd4rk 2y ago
  This has been extensively studied and you are wrong. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30418-0/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
  - Vecr 2y ago
    I don't think I am, in the provirus state you can think of it as essentially a DNA virus in an inert state, and if the DNA fragments the right way it would turn into something similar to a bare DNA vaccine. That design of vaccine essentially does not work, but they have an effect that is not literally zero. I think there's enough holes in the layers of "Swiss cheese" that normally prevent this chain of events that U does not literally equal U. Edit: right, I'm also assuming the possibility of provirus mutation before this chain of events, and I don't think anyone can deny at least the mutation of HIV before it becomes a provirus.
    - theideaofcoffee 2y ago
      Are you a virologist, epidemiologist or other specialist with peer-reviewed research pointing in the direction opposite to the conclusions in the paper above? If so, you should publish your findings because that would be a huge refutation of current knowledge and would possibly help the epidemiology of transmission in the greater public. Until then, I'll take the word of public health practitioners who've been steeped in the field for their entire careers. Their work has been significant enough to be published in Lancet which is a pretty good signal to this layman (though with a bachelor's of science in an unrelated scientific field, so no stranger to reading primary literature).
      - Vecr 2y ago
deleted 2y ago
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hyrix 2y ago
Transmission has never been found when the number of copies of the HIV RNA are below 200 copies/mL--the quantity of virus matters. For context, the typical ejaculation from someone untreated contains between 10,000 and 1,000,000 copies/mL. With treatment, the average is 1-10 copies/mL. Besides HPTN 052, there have been three other studies--PARTNER, PARTNER 2, and DISCOVER, of real-world (condomless) usage in mixed serotype couples https://www.idsociety.org/science-speaks-blog/2021/u--u-the-evidence-is-in.-spreading-the-word-that-undetectable--untransmissable-is-the-next-crucial-step/#/+/0/publishedDate_na_dt/desc/ https://www.idsociety.org/science-speaks-blog/2021/u--u-the-... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8942556/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8942556/
dyauspitr 2y ago
From what I’ve read you need an absolute minimum of 10 virons for infection to happen.
- etiam 2y ago
  I find "absolute minimum" an unfortunate choice of phrasing when the process necessarily has large elements of randomness and could in principle well proceed from a single cell getting successfully infected. But it's interesting to note that the way HIV generates its infamous genetic variability can result in a remarkably large fraction of the virions being mutated beyond viability. https://journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.1002251 https://journals.plos.org/plosbiology/article?id=10.1371/jou... The infection risk would have to involve a factor of virions getting to a susceptible cell without getting destroyed anyway of course, but given that many of the contenders might not be capable of infecting even if they get there it seems even more understandable if one would usually end up with 10 as the number needed to satisfy some chosen level of statistical significance.

toomuchtodo 2y ago

From that same link you cite: > Findings from the breakthrough NIH-funded HPTN 052 clinical trial, a decade-long study involving more than 1,600 heterosexual couples, offered clear-cut evidence that ART that consistently suppresses HIV also prevents sexual transmission of the virus. In 2011, the HPTN 052 investigators reported that starting ART when the immune system is relatively healthy, as opposed to delaying therapy until the immune system has been weakened by the virus, dramatically reduces the risk of sexually transmitting HIV. The protective effect of starting ART early was sustained over four additional years of follow-up. Importantly, when viral loads were measured, no HIV transmissions were observed when ART consistently, durably suppressed the virus in the partner living with HIV. Wild speculation is that the genetic material you mention is inactivated and therefore unable to transmit the virus, but is still detectable. I am just an internet rando surfing the knowledge graph, but the science appears sound. https://www.nih.gov/news-events/news-releases/hiv-control-through-treatment-durably-prevents-heterosexual-transmission-virus https://www.nih.gov/news-events/news-releases/hiv-control-th... https://web.archive.org/web/20150106032855/http://www.niaid.nih.gov/news/newsreleases/Archive/2011/Pages/HPTN052Breakthrough.aspx https://web.archive.org/web/20150106032855/http://www.niaid.... https://www.clinicaltrials.gov/study/NCT00074581 https://www.clinicaltrials.gov/study/NCT00074581

pstrateman 2y ago
>1,600 heterosexual couples Is there a similar study of gay men who are not in a monogamous relationship? Studying the group with the lowest transmission rate who could still transmit seems kind of dishonest.
- foldr 2y ago
  It's not 'dishonest'. It's important data for parts of the world where heterosexual transmission of the virus is common. And yes, there is a similar study: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30418-0/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

deleted 2y ago

[deleted]

Vecr 2y ago

I don't buy U=U, I've not seen a proper impossibility proof re. provirus mutation. There's probably infections drowned out against the background rate.

4fterd4rk 2y ago
This has been extensively studied and you are wrong. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30418-0/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
- Vecr 2y ago
  I don't think I am, in the provirus state you can think of it as essentially a DNA virus in an inert state, and if the DNA fragments the right way it would turn into something similar to a bare DNA vaccine. That design of vaccine essentially does not work, but they have an effect that is not literally zero. I think there's enough holes in the layers of "Swiss cheese" that normally prevent this chain of events that U does not literally equal U. Edit: right, I'm also assuming the possibility of provirus mutation before this chain of events, and I don't think anyone can deny at least the mutation of HIV before it becomes a provirus.
  - theideaofcoffee 2y ago
    Are you a virologist, epidemiologist or other specialist with peer-reviewed research pointing in the direction opposite to the conclusions in the paper above? If so, you should publish your findings because that would be a huge refutation of current knowledge and would possibly help the epidemiology of transmission in the greater public. Until then, I'll take the word of public health practitioners who've been steeped in the field for their entire careers. Their work has been significant enough to be published in Lancet which is a pretty good signal to this layman (though with a bachelor's of science in an unrelated scientific field, so no stranger to reading primary literature).
    - Vecr 2y ago

deleted 2y ago

[deleted]

hyrix 2y ago

Transmission has never been found when the number of copies of the HIV RNA are below 200 copies/mL--the quantity of virus matters. For context, the typical ejaculation from someone untreated contains between 10,000 and 1,000,000 copies/mL. With treatment, the average is 1-10 copies/mL. Besides HPTN 052, there have been three other studies--PARTNER, PARTNER 2, and DISCOVER, of real-world (condomless) usage in mixed serotype couples https://www.idsociety.org/science-speaks-blog/2021/u--u-the-evidence-is-in.-spreading-the-word-that-undetectable--untransmissable-is-the-next-crucial-step/#/+/0/publishedDate_na_dt/desc/ https://www.idsociety.org/science-speaks-blog/2021/u--u-the-... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8942556/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8942556/

dyauspitr 2y ago

From what I’ve read you need an absolute minimum of 10 virons for infection to happen.

etiam 2y ago
I find "absolute minimum" an unfortunate choice of phrasing when the process necessarily has large elements of randomness and could in principle well proceed from a single cell getting successfully infected. But it's interesting to note that the way HIV generates its infamous genetic variability can result in a remarkably large fraction of the virions being mutated beyond viability. https://journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.1002251 https://journals.plos.org/plosbiology/article?id=10.1371/jou... The infection risk would have to involve a factor of virions getting to a susceptible cell without getting destroyed anyway of course, but given that many of the contenders might not be capable of infecting even if they get there it seems even more understandable if one would usually end up with 10 as the number needed to satisfy some chosen level of statistical significance.