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Treat and Tell?

Dale Symons and Steve Lambert

Paul, aged 28, is a long standing patient of yours, and has arrived for his usual three monthly appointment. You have known Paul since his family moved to your general practice’s area 11 years ago. Paul caught HIV 4 years ago, and he has been seeing you for his ongoing management over this time. You have witnessed Paul falling in love, and marrying Louise 14 months ago. Paul is not on any treatment for his HIVas he has maintained strong health. His CD4 count has remained above 500 and his viral load is very low, indicating that he does not currently need treatment for the infection itself or to prevent other opportunistic infections. There are no signs of deterioration of his immune system or of his health generally.

Paul asks you about going on treatment, not because his clinical situation requires it but because he wants to attempt to lower his viral load to reduce the chance of passing HIV onto his wife. “Treatment as prevention” has been in the media because of report …