Not anonymous, it was me asking.

Question I've been Undetectable for 10-15 years with 1000 t-cells. I often hear about HIV still being in semen, even when undetectable in blood work. I read that after 3 years, in a limited study, there was no viral shedding in semen. Since there were no HIV transmissions from Undetectable partners in all studies, how important is undetectability in semen? Does ART "tag along" with semen once it's released from it's reservoir to render HIV ineffective? I've never had a semen test. Should I?


Some studies have shown low levels of detectable virus in semen despite undetectable levels in the blood. But while this is often mentioned as a theoretical concern, no one has ever shown that it matters in terms of transmission, which doesn’t seem to occur in people with undetectable plasma viral loads. The semen levels may be too low to really transmit HIV, and they’re probably declining further over time.

No one is recommending routine semen viral loads, and I doubt that you could find a commercial lab that would run one. My advice is to assume your plasma viral load reflects what’s going on in your semen.