HIV transmission If HIV carriers are adequately treated with antiretroviral drugs and have achieved sustained viral suppression (BII), the risk of HIV transmission in serodiscordant couples can be virtually eliminated which means that having a healthy child is now is a reality.
Sexual transmission of HIV in serodiscordant couples (one HIV positive and the other HIV negative) is not only a medical but also a bioethical problem, in that it can affect their sexual relationships. We have treated this issue before when the studies were less conclusive (see HERE).
HIV discordant couple
In such cases, we must distinguish two distinct groups: heterosexual couples and homosexual male couples.
Now, a comprehensive study has just been published in The Lancet confirming the efficacy of antiretroviral therapy in serodiscordant gay male couples.
In 2011, a study published in Science showed a 96% reduction in the sexual transmission of HIV in serodiscordant couples when the infected member was successfully treated with antiretroviral therapy.
However, this study only included a small number of homosexual male couples and did not take into account whether or not couples used condoms in their sexual relationship.
In 2016, the results of another study, the PARTNER study, were reported, which included 1116 serodiscordant couples, 340 of them homosexual male couples; nevertheless, for a number of reasons, there were unable to achieve good results (see HERE).
This gave rise to another study, the PARTNER 2, the results of which are now published in The Lancet. This study, conducted between 2014 and 2017, included an additional 495 gay male couples who did not use condoms during sex. The findings have been very encouraging, as the researchers did not detect HIV transmission from the infected member of the couple to the healthy one in any case. The authors, therefore, concluded that the risk of HIV transmission in these couples is virtually zero when the viral load in the infected member is less than 200 copies/ml in the years prior to their inclusion in the study.
These findings suggest that if HIV carriers are adequately treated with antiretroviral drugs and has achieved sustained viral suppression (BII), the risk of HIV transmission in serodiscordant couples can be virtually eliminated, which would undoubtedly have broad and positive medical and ethical consequences, especially if this new treatment regimen is used for serodiscordant heterosexual couples.
Bioethical comment
From a bioethical point of view, dissemination of the message that the risk of transmission of HIV in the context of suppressive ART (Antiretroviral therapy) virally is zero should be the issue of a huge campaign. This dissemination is necessary to promote the benefits of early testing and treatment also avoiding new infections.
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