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GENEVA -- Using a condom is still the safest protection against AIDS, United Nations health agencies said Friday after Swiss researchers claimed patients on retroviral drugs do not transmit the virus.
UNAIDS and the World Health Organisation said in a joint statement that they "strongly recommend a comprehensive package of HIV prevention approaches, including correct and consistent use of condoms."
People taking anti-retrovirals can have undetectable amounts of HIV virus in their blood "at certain stages of their treatment", the Geneva-based agencies said in today's statement.
"However, it has not been proven to completely eliminate the risk of transmitting the virus," UNAIDS and WHO said.
"More research is needed to determine the degree to which the viral load in blood predicts the risk of HIV transmission and to determine the association between the viral load in blood and viral load in semen and vaginal secretions."
Switzerland's Federal AIDS Commission published a report on Wednesday claiming that couples where one partner is HIV positive do not need to use a condom to prevent transmitting the disease, as long as retroviral therapy is followed regularly and has suppressed the virus in the blood for at least six months.
The claim sparked concern by AIDS charities who noted that the scientific research is focused on heterosexual couples and vaginal rather than anal sex.
"The real thing missing (from the Swiss advice) is about anal sex and getting a new sexually transmitted infection," said Roger Peabody of the London-based Terrence Higgins Trust AIDS charity.
Swiss AIDS experts said Thursday that some people with HIV who are on stable treatment can safely have unprotected sex with non-infected partners.
The proposal, published this week in the Bulletin of Swiss Medicine, astonished leading AIDS researchers in Europe and North America who have long argued that safe sex with a condom is the single most effective way of preventing the spread of the disease -- apart from abstinence.
"Not only is (the Swiss proposal) dangerous, it's misleading and it is not considering the implications of the biological facts involved with HIV transmission," said Jay Levy, director of the Laboratory for Tumor and AIDS Virus Research at the University of California in San Francisco.
The Swiss National AIDS Commission said patients who meet strict conditions, including successful antiretroviral treatment to suppress the virus and who do not have any other sexually transmitted diseases, do not pose a danger to others.
"There is still some concern that you can never guarantee that somebody will not be infectious, and the evidence I have to say is not conclusive," said Charlie Gilks, director of AIDS treatment and prevention at WHO.
"Many countries in western Europe would regard this as an interesting experiment," he said, adding it was unlikely they would follow suit anytime soon.
The Swiss scientists took as their starting point a 1999 study by the U.S. Centers for Disease Control and Prevention, which showed that transmission depends strongly on the viral load in the blood.
The Swiss said other studies had also found that patients on regular anti-AIDS treatment did not pass on the virus, and that HIV could not be detected in their genital fluids.
"The most compelling evidence is the absence of any documented transmission from a patient on antiretroviral therapy," said Pietro Vernazza, head of infectious diseases at the cantonal hospital of St.Gallen in eastern Switzerland and one of the authors of the report.
"Let's be clear, the decision has to remain with the HIV-negative partner," he said.
The studies cited by the Swiss commission did not themselves definitively conclude whether people with HIV and on antiretroviral treatment could safely have unprotected sex without passing on the virus.
In practice the recommendation would affect about a third of HIV patients in Switzerland, Vernazza said, but added that patients and their partners would benefit from greatly increased quality of life, such as being able to have children without fear of passing on the virus.
Even in Switzerland, where some 6,000 people are on antiretrovirals, as little as a third of patients could be considered suitable, Gilks said. The guidelines from the Swiss commission require patients to adhere strictly to their treatment regime and many people do not.
He said WHO was concerned that the Swiss proposal could be misinterpreted to imply that everybody who is on treatment can have unprotected sex.
"It may be fine for Switzerland, it may be fine for a few other countries who have similar small numbers of patients who are very carefully followed up," said Gilks. "But from our point of view globally, we are not going to be changing our recommendations."
Full article: AIDS experts: Unprotected sex OK for some - AIDS- msnbc.com
Health agencies stick to condom advice after Swiss AIDS study | AFP
HIV therapy does not eliminate transmission risk-WHO | Reuters South Africa