HIV Weekly - 14th January 2009

HIV treatment and care

Infectiousness

HIV is present in potentially infectious quantities in blood, semen, vaginal fluids and breastmilk and as a result HIV can be passed on through injecting drug use, unprotected sex, and from a mother to her baby.

It’s not inevitable that a person exposed to HIV will become infected with the virus.  One of the factors that affects this risk is the viral load of the person with HIV. HIV treatment lowers viral load both in blood and genital fluids.

There’s recently been a lot of debate about the infectiousness of people taking HIV treatment who have an undetectable viral load.

Swiss doctors kick-started the debate about a year ago. In a statement, they said that a person taking HIV treatment, who’d had an undetectable viral load for at least six months, who took all their medication and who didn’t have a sexually transmitted infection, was not infectious to their heterosexual partners.

The current consensus seems to be that HIV treatment reduces the risk of sexual transmission, but that a small risk may still be present.

A year after the Swiss statement comes the ‘Israeli statement’. An HIV-positive surgeon in Israel is being allowed to continue working. He or she is taking HIV treatment and has an undetectable viral load.

Healthcare workers with HIV are routinely banned from surgical procedures of any kind, even very minor ones such as stitching wounds. The Israeli statement is the first official acknowledgement that HIV treatment reduces the risk of bloodborne HIV transmission to such low levels that a doctor, nurse or midwife can continue working.

It could have real implications for the careers of HIV-positive healthcare workers – and have a generally destigmatising effect for people with HIV.

HIV Treatment Update  looked in detail at the question of whether healthcare workers should be allowed to carry out surgical procedures in the August/September issue.