[vkou]

In the 1980s, getting HIV was a quick death sentence.

In the 2010s, getting HIV means that you are likely to live until... Your 70s. (Assuming you have access to medication.)

The problem is that you need to take expensive medication for the rest of your life. And that you can infect other people.

[spklin]

Successful treatment means you cannot infect others:

https://www.reuters.com/article/us-health-hiv-transmission/p...

This is why "treatment as prevention" is important part of stopping further spread.

[otakucode]

The infecting other people is mostly theoretical. As far as I know there is no actual instance of transmission from a person with an undetectable viral load on antiretroviral drugs to an uninfected person.

[hn_throwaway_99]

Is this somewhat of a tautology, though? I mean, it's not particularly uncommon for a patient to be undetectable on HAART and then have their treatment regimen "fail" at a later date (often because of lack of strict compliance by the patient - not sure if this is much less common today with easier-to-follow regimens).

Thus, if someone is undetectable but then their treatment fails, they would become detectable and able to transmit the virus. But they could still infect someone else before they discovered their treatment failed.

[esm]

It even works the other way around. IIRC, there have been something like 2 documented cases of HIV(-) people becoming seropositive while taking PrEP as prescribed.

[yeukhon]

> an undetectable viral load on antiretroviral drugs to an uninfected person

Can you please put this into simpler terms? I am pretty confused. Because HIV transmission is not a theoretical and is not a myth. My understanding is, OP meant to say "transmission of HIV via known risky activities."

--EDIT--

Thank you for those clarifying. Often the unfamiliar technical terms can throw me off.

[kentosi]

If you're getting treatment, the amount of HIV in your blood is regularly measured as your "viral load".

It's possible, with treatment, for people with HIV to have a viral load labelled undetectable.

To date, from an article I read, there have been no recorded transmissions from people with an undetectable viral load.

https://www.preventionaccess.org/faq

[vkou]

Two questions arise:

How many people taking retrovirals have undetectable levels of HIV?

Are those people using condoms?

[tatterdemalion]

The PARTNER study studied 767 serodiscordant couples, with the HIV positive partner undetectable. All participating couples did not use condoms at least some of the time. They found zero cases in which the undetectable partner infected the negative partner.

http://www.aidsmap.com/No-one-with-an-undetectable-viral-loa...

Frequent testing and early intervention are very effective to achieving an undetectable viral load. The adoption of these as public health policy, as well as making available of prophylactic measures for at risk populations, has been effective at combating the spread of HIV - e.g. in San Francisco, where infection rate has been declining significantly over the last 5 or so years.

[spklin]

Undetectable is the standard of care and is the definition for the treatment "working". Viral load is checked regularly after starting treatment. If it doesn't become undetectable quickly with first line meds, there may be compliance or resistance issues and treatment approach is changed. With current protocols the main reason for treatment failure is mental health/substance abuse interfering with adherence.

The studies on transmission are using sero-discordant couples who are not using condoms. The evidence/confidence has been building over time with multiple studies in which no transmissions were observed.

http://www.catie.ca/en/catienews/2016-09-06/negligible-risk-...

The HPTN 052 randomized study was halted early because the evidence so strongly favored the treatment arm. In the PARTNER observational study, no transmissions were observed in the study at all. The evidence is very strong.

[VeryAnonymous]

Not a professional, but my wife has HIV (and I don't), so I have a personal interest in the subject.

> How many people taking retrovirals have undetectable levels of HIV?

According to my wife's doctor, most of them. And if that changes, they attempt to adjust treatment to return to that state.

BTW, undetectable appears to mean 20 copies of viral DNA per ml of blood.

> Are those people using condoms?

Well, we were, for many years. But we wanted children, and so after her doctor actually encouraged us we conceived them the old-fashioned way. I really, really enjoyed sex without a condom after so many years, I must say.

Now we have all the children we want, and we ought to go back to condoms, but I find myself wondering about the risk vs. reward. I suppose we'll go back to condoms, but I yearn to forgo them -- it's just less intimate. I wonder how other couples feel.

[wellboy]

There was a study a few days ago that found out that below threshold viral load means that the patient isn't infectious anymore.

https://www.intomore.com/impact/cdc-acknowledges-that-undete...

Don't take my word for it though, would check with doctors.

[maxerickson]

They are responding to The problem is that you need to take expensive medication for the rest of your life. And that you can infect other people.

They are saying that there are no recorded instances of someone that is taking antiretroviral drugs and has an undetectable viral load actually transmitting the virus.

[g00gler]

Interesting. What about mother-to-baby transmission?

[VeryAnonymous]

Possible, but apparently more a theoretical risk. Certainly small compared to other birth risks.

Until a few years ago, C-section was recommended, but the current wisdom is that vaginal birth poses no greater risk for the baby.

Same with breastfeeding. Until a few years doctors would call CPS if a HIV+ woman admitted to breastfeeding her child. Now, our doctors encouraged my HIV+ wife to breastfeed.

OTOH she was the second (or third?) HIV+ woman in our city who dared to.

Worked out for us. Both kids are HIV-, as am I.

[jessriedel]

> In the 1980s, getting HIV was a quick death sentence.

It has never been quick.

> Without treatment, average survival time after infection with HIV is estimated to be 9 to 11 years, depending on the HIV subtype

https://en.wikipedia.org/wiki/HIV/AIDS#Prognosis

You may be thinking of the ~1 year survival times after an AIDS diagnosis, but HIV is usually latent for a decade after initial infection.

[mfoy_]

The passing of the sentence was quick, the execution of it was painful and slow.

[fatjokes]

So exactly like an American death sentence.

[loeg]

In the 80s HIV wasn't really diagnosed until it had reached the AIDS level, was it? AIDS itself was first diagnosed in 1981 and HIV wasn't isolated until 1983 and didn't have that name until 1986.

I've tried to do a brief search for earliest HIV (non-AIDS) diagnosis, but many websites use AIDS and HIV interchangeably.

[jessriedel]

Sure, but vkou didn't say "being diagnosed with AIDS was a quick death sentence" Importantly, you could be practicing very unsafe sex for a decade with no apparent consequences, which is not what one would conclude from vkou's comment.

[rangibaby]

"And The Band Played On" might have something about it. I don't remember because I read it a lot time ago.

[stan_rogers]

To be fair, "getting HIV" wasn't really a thing in the dark days. You found out when you developed AIDS, because some weird opportunistic thing popped up. Pre-AIDS diagnosis came along after an awful lot of people died slowly of things that folks ordinarily don't get or don't die from.