Why Experts Say You Can’t Spread HIV When You’re on Meds

Dr. Oz with Charlie Sheen on set

When Charlie Sheen told the world he had HIV in November of 2015 it turned out to be a major moment for public health. In fact, according to a study published in JAMA Internal Medicine, Charlie’s announcement was among the top 1 percent of historic HIV-related media events and led to millions of people seeking out information on HIV and its prevention.

Despite that, we have found that there is still a lot of misunderstanding out there about what it means to be HIV-positive today.

Last week a headline in the New York Post proclaimed “Charlie Was Right.” The article was referring to statements he and his doctor made on our show and elsewhere when they claimed that it was impossible, or at least almost impossible, for Charlie to infect anyone else with the HIV virus. For people not keeping up with where HIV treatment is today—that statement was shocking. It’s also hard to understand without some additional context, so back in November we wrote about it to help explain how this could be.

The current regimen of HIV medications, if taken daily as prescribed, are able to suppress the HIV so much that we cannot detect any virus in the blood of most people who are infected. If there were no virus circulating in someone’s body, then theoretically it would not be possible for that person to transmit the virus to another. So far this is actually what the studies have shown. In fact, in the studies examining this, there has never been a transmission of the virus from an HIV-positive person with an undetectable viral load to another person. Of course this doesn’t mean it’s impossible, but it is extremely unlikely. That also doesn’t mean that it’s a good idea to have sex without a condom though, because a condom takes away the need to trust that your partner actually does have an undetectable viral load.

The recent New York Post article reported that Dr. Demetre Daskalakis, the assistant commissioner of the NYC Department of Health and Mental Hygiene Bureau of HIV Prevention and Control, one of the biggest health departments in the world, made a statement to clear things up. According to the New York Post Dr. Daskalakis recently said, “that HIV patients with undetectable viral levels who faithfully take their medications ‘cannot actively transmit HIV, and we should not treat them that way.’”  According to Charlie Sheen’s medical records, in November of 2015, his viral load had been undetectable since just after his diagnosis four years earlier.

The fact that regularly taking HIV medications can make it highly unlikely for HIV-positive individuals to transmit the virus is something that people in public health are very excited about. You can get an idea why in this figure from the CDC’s data, known as the HIV Care Continuum.

care-continuum-improvements

The first bar shows that of all the people in the U.S. living with HIV, about 86 percent of them know their diagnosis and 14 percent are undiagnosed. Not bad, but we need to do much better. Things get worse as we go down the chart, though. The last two bars show that of all the people living with HIV, only 37 percent are on anti-retroviral therapy and only 30 percent of them have an undetectable viral load. If we could get all of these people in treatment and then virally suppressed, based on what we said above, it would be virtually impossible for them to transmit the virus to others. This means that we could potentially stop transmission of HIV from the infected to the uninfected and actually eradicate this disease.