Transmission has never been found when the number of copies of the HIV RNA are below 200 copies/mL--the quantity of virus matters.

For context, the typical ejaculation from someone untreated contains between 10,000 and 1,000,000 copies/mL. With treatment, the average is 1-10 copies/mL.

Besides HPTN 052, there have been three other studies--PARTNER, PARTNER 2, and DISCOVER, of real-world (condomless) usage in mixed serotype couples

https://www.idsociety.org/science-speaks-blog/2021/u--u-the-...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8942556/

From that same link you cite:

> Findings from the breakthrough NIH-funded HPTN 052 clinical trial, a decade-long study involving more than 1,600 heterosexual couples, offered clear-cut evidence that ART that consistently suppresses HIV also prevents sexual transmission of the virus. In 2011, the HPTN 052 investigators reported that starting ART when the immune system is relatively healthy, as opposed to delaying therapy until the immune system has been weakened by the virus, dramatically reduces the risk of sexually transmitting HIV. The protective effect of starting ART early was sustained over four additional years of follow-up. Importantly, when viral loads were measured, no HIV transmissions were observed when ART consistently, durably suppressed the virus in the partner living with HIV.

Wild speculation is that the genetic material you mention is inactivated and therefore unable to transmit the virus, but is still detectable. I am just an internet rando surfing the knowledge graph, but the science appears sound.

https://www.nih.gov/news-events/news-releases/hiv-control-th...

https://web.archive.org/web/20150106032855/http://www.niaid....

https://www.clinicaltrials.gov/study/NCT00074581

>1,600 heterosexual couples

Is there a similar study of gay men who are not in a monogamous relationship?

Studying the group with the lowest transmission rate who could still transmit seems kind of dishonest.

It's not 'dishonest'. It's important data for parts of the world where heterosexual transmission of the virus is common.

And yes, there is a similar study: https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

I don't buy U=U, I've not seen a proper impossibility proof re. provirus mutation. There's probably infections drowned out against the background rate.

This has been extensively studied and you are wrong.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

I don't think I am, in the provirus state you can think of it as essentially a DNA virus in an inert state, and if the DNA fragments the right way it would turn into something similar to a bare DNA vaccine. That design of vaccine essentially does not work, but they have an effect that is not literally zero. I think there's enough holes in the layers of "Swiss cheese" that normally prevent this chain of events that U does not literally equal U.

Edit: right, I'm also assuming the possibility of provirus mutation before this chain of events, and I don't think anyone can deny at least the mutation of HIV before it becomes a provirus.

Are you a virologist, epidemiologist or other specialist with peer-reviewed research pointing in the direction opposite to the conclusions in the paper above? If so, you should publish your findings because that would be a huge refutation of current knowledge and would possibly help the epidemiology of transmission in the greater public.

Until then, I'll take the word of public health practitioners who've been steeped in the field for their entire careers. Their work has been significant enough to be published in Lancet which is a pretty good signal to this layman (though with a bachelor's of science in an unrelated scientific field, so no stranger to reading primary literature).

I probably could write something, but HIV is an epidemiologist's game at this point, and I honestly think the epidemiologists want to say HIV can't transmit in ways that the Hepatitis B virus, a DNA virus, has clearly been demonstrated to transmit. If you press a virologist in private I'm not sure they'll stick to "can't", especially after the COVID-19 virus mutation rate fiasco, and, though not a virus, the prion situation.

I think "can't" deserves at least something physically (as in physics) unlikely, not something that's been demonstrated in a DNA virus previously (and like I said, HIV in provirus form is not unlike a DNA virus).

>Their work has been significant enough to be published in Lancet which is a pretty good signal to this layman (though with a bachelor's of science in an unrelated scientific field, so no stranger to reading primary literature).

i've no opinion on the topic at hand, but I would urge you to find a plethora of signals to form your opinions.

The Lancet has been responsible for quite a few negative 'public health' trends.

The Lancet is responsible, at least partially, for the whole 'vaccines == autism' thing of Andrew Wakefield's; and even ignoring that they have a history of poor review and retraction of work that ends up either being entirely wrong, or guilty of experimental misconduct.

In 1992 they published stuff that suggested a causal link between HIV infection and the oral polio vaccines.

In 1998 they published a (big tobacco funded) peper indicating that second hand smoke doesn't have as much risk as earlier thought.

In 2000 they published a study that claimed that St Johns Wort was as effective an anti-depressant as conventional SSRIs and TCAs.

Just because something has become 'prestigious' doesn't mean it should be trusted wholeheartedly.

This isn't about the Lancet specifically. It's about someone on the internet challenging the overwhelming medical consensus without providing a shred of evidence to support their claims. I can assure you that 'people saying things on the internet' have a far worse record on medical matters than the Lancet, or the medical consensus more generally.

You could try asking a virologist if they think it's possible for the HIV-1 provirus to ever be in a state where it could theoretically be infectious given the right DNA fragmentation.

Why don't you ask one and post what they say here? Or better still, post a reference to some published work that makes your point.

From what I’ve read you need an absolute minimum of 10 virons for infection to happen.

I find "absolute minimum" an unfortunate choice of phrasing when the process necessarily has large elements of randomness and could in principle well proceed from a single cell getting successfully infected.

But it's interesting to note that the way HIV generates its infamous genetic variability can result in a remarkably large fraction of the virions being mutated beyond viability.

https://journals.plos.org/plosbiology/article?id=10.1371/jou...

The infection risk would have to involve a factor of virions getting to a susceptible cell without getting destroyed anyway of course, but given that many of the contenders might not be capable of infecting even if they get there it seems even more understandable if one would usually end up with 10 as the number needed to satisfy some chosen level of statistical significance.