One of the hottest topics in HIV at the moment is the impact that HIV treatment has on the infectiousness of people taking it.

The debate was kick-started in early 2008 when senior HIV doctors in Switzerland issued a statement saying that in certain circumstances, people taking HIV treatment who had an undetectable viral load are not infectious to their sexual partners.

Few experts have gone as far as the Swiss and said that people taking treatment with an undetectable viral load are never infectious.

However, a general consensus seems to be emerging that taking HIV treatment and having an undetectable viral load does significantly reduce infectiousness. In April the French National AIDS Council issued a statement broadly supporting this position, but highlighting what they believe to be limitations in this approach and gaps in current knowledge.

Like many other experts, they noted limitations with treatment as a method of prevention. Even if a person has an undetectable viral load, there’s some evidence that there can still be a small risk of transmission. Furthermore, poor adherence and sexually transmitted infections can all increase viral load and increase the risk of infectiousness.

Treatment is not considered a replacement for condom use, and all the information about its impact on infectiousness comes from studies involving monogamous heterosexual couples.

But the French health ministry has now issued its own statement rejecting the idea of treatment as prevention. It states that consistent condom use offered maximum protection against HIV. It also highlights the lack of information about treatment as prevention and gay men, or about the use of treatment as a sole prevention strategy.

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