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Africa
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Conclusion
Published in Eboko Fred, Public Policy Lessons from the AIDS Response in Africa, 2020
The dream began with the publication of a Swiss protocol showing that the transmission of the virus in a sero-discordant couple (a sero-positive person and a sero-negative person) decreases significantly once the viral load of the infected person has dropped in connection with early initiation of antiretroviral (ARV) therapy. Following almost a decade of research on this issue (Quinn et al., 2000; Castilla et al., 2005; Vernazza et al., 2008), the Swiss Federal Commission not only prompted an international debate, but also validated, at the institutional level, medical evidence that goes against the dogmas, logic, and idioms of HIV prevention. Subsequently, no scientific study was produced to challenge the “Swiss Statement”, even if the political and practical application of the new medical knowledge were subject to caution. At issue was the translation of scientific evidence into effective interventions at the international level.1 The effects of these discoveries were nevertheless felt in Africa, especially because they spurred a gradual reinforcement of the idea of early treatment. This is the case of “Test and Treat”.
Viral disease and assisted reproduction technology
Published in David K. Gardner, Ariel Weissman, Colin M. Howles, Zeev Shoham, Textbook of Assisted Reproductive Techniques, 2017
Carole Gilling-Smith, Pietro Vernazza
In HIV-serodiscordant couples, natural conception should only be proposed once the blood viral load has been shown to have fallen below 50 copies/mL. Intermittent low-level blips of viral load (in the range of 50–200 copies) have been reported, but do not appear to increase the risk of HIV transmission. While the Swiss Statement defined the absence of sexually transmitted infections as an additional safeguard, the additional evidence did not reveal an increase of the HIV transmission risk from non-viremic individuals when sexually transmitted infections were present (7). Therefore, the testing for sexually transmitted infections is not a requirement to reduce HIV transmission risk in HIV-serodiscordant couples attempting to conceive naturally, although in the context of offering assisted reproduction to those with fertility issues, it would form part of the normal work-up.
AIDS
Published in Omar Bagasra, Donald Gene Pace, A Guide to AIDS, 2017
Omar Bagasra, Donald Gene Pace
Given the high success rate in vertical transmission for HIV prevention, specialists realized that a similar protection could likely be afforded in horizontal cases (spouse-to-spouse, or partner-to-partner). Serodiscordant (or serodifferent) couples are those in which one individual is HIV-negative and the other HIV-positive. The Swiss National AIDS Commission took what at that time appeared to be a bold stand when they announced in 2008 that HIV cannot be transmitted sexually if the infected partner is taking ARV therapy, has a viral load that has remained below the detectable level (40 copies per milliliter) for at least six months, and has no other STIs. The announcement, known as the Swiss statement, was later clarified to explain that it did not mean there was no chance of HIV transmission but that the probability was so low that it was in the range of everyday risks, about 1 in 100,000. Although considered dangerous at the time, the Swiss statement was research-based and has proven to be sound. Very few HIV-transmissions have occurred among discordant couples. The analysis was based primarily on heterosexual unions, which still left the question whether men who have sex with men (MSM) would find the same level of protection [13,14,15–16].
Treatment as prevention (TasP) and perceived sexual changes in behavior among HIV-positive persons: a French survey in infectious diseases departments in Paris
Published in AIDS Care, 2020
Camille Couffignal, Emmanuelle Papot, Aurélie Etienne, Sylvie Legac, Cédric Laouénan, Danièle Beres, Laurent Blum, Marie-Aude Khuong-Josses, Annie Lepretre, Patrick Papazian, Yazdan Yazdanpanah, Elisabeth Bouvet
The “Swiss Statement” released in 2008 was a milestone in the history of HIV infection and its burden. It stated that PLHIV on ART with therapeutic success and without sexually transmitted infections did not transmit HIV (Vernazza, Hirschel, Bernasconi, & Flepp, 2008). It is now widely proved that TasP is effective at the individual level (reducing morbidity and mortality) and at the population level (reducing HIV transmission).