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New Swiss guidelines for PLWHA on effective ARV treatment
F.M. Wasserfallen1, R. Staub2, H. Witzthum3, D. Oertle4, M. Flepp5, D. Bruttin3, E. Bernasconi6, B. Hirschel7, P. Vernazza8
1Swiss Federal Commission on AIDS-related issues, Berne, Switzerland, 2Swiss Federal Office of Public Health, Berne, Switzerland, 3Swiss AIDS Federation, Zurich, Switzerland, 4Gemeinschaftspraxis, Zurich, Switzerland, 5Clinic Im Park, Zurich, Switzerland, 6Ospedale Civico, Lugano, Switzerland, 7Geneva University Hospital, Geneva, Switzerland, 8Kantonsspital, Division of Infectious Diseases, Department of Medicine, St Gallen, Switzerland
Issues: The Swiss Federal Commission on AIDS-related issues produced a statement that the risk of HIV-sexual transmission from an infected individual on effective ART is in the range of other well accepted risks of daily life. The statement didn’t claim zero risk but rather a very low risk similar to the risk of transmission through oral sex without ART. The aim is to standardize physician’s counseling in Switzerland, and to alleviate fears of PLWHA of transmitting HIV to their steady partner.
Description: Effective ART is given if i) the HIV-infected person is consistently adhering to ART and is regularly followed by a physician; ii) viral load is below the limits of detection for more than 6 months.. Furthermore, no active STI must be present. PLWHA meeting those conditions are required to undergo comprehensive counseling together with their steady partners, allowing those living in a steady sero-different partnership to modify their individual risk management strategy. It is crucial that the counselling be addressed to both partners. Heterosexual couples need to additionally consider issues of conception under this new perspective. Furthermore, the Commission statement will have important implications with respect to Swiss legal practice, which still allows criminal prosecution of PLWHA having unprotected sex with their consenting HIV-negative partners.
Lessons learned: PLWHA have responded with great consent and relief to this statement. Changes in risk counseling have just started at time of abstract submission. Communication of those general prevention measures which haven’t changed through this statement did continue as will monitoring within the Swiss HIV Cohort Study and other settings. Comprehensive counseling is needed to communicate and teach individual risk assessment.
Next steps: The effects of the new counselling guidelines will further be monitored while prevention messages will integrate this more complex reality with sound information to further reduce high risk behavior.
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