HIV transmission under highly active antiretroviral therapy.

1806 www.thelancet.com Vol 372 November 22, 2008 iveness of treat ment in reducing the risk of HIV trans mission per sexual act was about the same as has been report ed for condoms.” There fore, even with their high esti mates, Wilson and colleagues con fi rm the Swiss statement and even docu ment a higher risk for condom use (with out treatment) than for treatment alone. Finally, the major limitation is the neglect of the role of sexually transmitted diseases (STDs), which are well known to fuel the HIV epidemic. In the Rakai study, genital discharge and dysuria were associated with increased risk of transmission. Thus, trans mission fi gures in the pre sence of STDs over esti mate the residual risk under HAART in the absence of STDs. Since the “Swiss statement” is often mis inter preted, we would like to reempha sise the main point. The risk of sex ual trans mission of HIV is negligibly low if three con ditions are met: (1) the HIV-infected patient is receiving antiretro viral therapy with excellent ad her ence; (2) blood viral load has consistently been undetectable (<40 copies per mL) for more than 6 months; and (3) no STDs are present in either of the partners. The statement also made it clear that it is up to the HIV-negative part ner to decide whether he or she wants to stop using condoms with the treat ed partner and accept the residual risk.