Select Committee on Health Written Evidence


Letter from the Chief Medical Officer, Sir Liam Donaldson, Department of Health to the Chairman of the Committee (5H 1B)


  At the Health Select Committee evidence hearing on 10 February on New Developments in HIV/AIDs and Sexual Health Policy, Melanie Johnson suggested that I write to clarify some of the issues around HIV viral load and the risk of HIV transmission.

  Highly active antiretroviral therapy (HAART) where effective can significantly reduce HIV viral load (ie amount of HIV virus in a sample). An undetectable HIV viral-load is the goal of anti-HIV treatment. But as Melanie Johnson indicated, a reduced or undetectable viral load does not mean that a person is not infectious. The patient information booklet HIV and Sex produced by the National AIDS Manual provides a useful summary on this issue. It states that although many people with undetectable viral load in their blood also have an undetectable viral load in their sexual fluids, this is not always the case. Some people with undetectable viral load in their blood have quite high viral load in their sexual fluids which could be high enough to infect someone.

  The NAM booklet also indicates that studies conducted in men have found that having an untreated sexually transmitted infection, particularly gonorrhoea, increases the chance that viral load will be detectable in semen. HIV can also be present in cells and these could transmit HIV even when a person has an undetectable viral load.

  Through its national health promotion work the Department funds, amongst others, the Terrence Higgins Trust and the African HIV Policy Network to produce information resources which also address the needs of people living with HIV. These include messages on the importance of using a condom, not only to prevent further transmission but also to avoid the transmission of other STIs and drug-resistant HIV.

February 2005

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