Good news for people living with HIV & their sexual partners

A host of health organizations acknowledge that undetectable means untransmittable (U=U). This means if someone has HIV but is on treatment and undetectable, there is zero risk of them passing it on.

The World Health Organization just reaffirmed this message… but goes even further.

WHO released a policy brief to coincide with this week’s International AIDS Society Conference on HIV Science in Brisbane, Australia. The brief not only states there is zero risk of transmission if someone has an undetectable viral load. It goes on to say that people with a suppressed but detectable viral load “have almost zero or negligible risk” of sexual transmission.

What does “suppressed but detectable” mean?

The WHO policy brief states, “There are three key categories for HIV viral load measurements: unsuppressed (more than 1,000 copies/mL), suppressed (detected but less than 1,000 copies/mL) and undetectable (viral load not detected by the test used).”

We know that those with an undetectable viral load cannot pass on the virus. This week, The Lancet posted a systematic review about the risk of transmission in those with “low-level” viral loads. That’s a viral load under 1,000.

The studies analyzed included 7,762 serodiscordant couples across 25 countries. They identified two cases of HIV transmission when the HIV-positive partner had a viral load between 200-1,000. Most cases of transmission occurred when the HIV-positive person had a viral load above 10,000.

In those two cases identified, 50 days or more had elapsed between the viral load test and the transmission. Therefore, their viral load may have been different at the time of transmission.

The authors concluded, “There is almost zero risk of sexual transmission of HIV with viral loads of less than 1,000 copies per mL. These data provide a powerful opportunity to destigmatize HIV and promote adherence to ART.”

The World Health Organization supports this message. It states, “People living with HIV who have an undetectable viral load … have zero risk of transmitting HIV to their sexual partner(s).” It continues, “People living with HIV who have a suppressed but detectable viral load and are taking medication as prescribed have almost zero or negligible risk of transmitting HIV to their sexual partner(s).”

That will be reassuring to many serodiscordant couples who might worry about small rises in viral load. Even if you’re not undetectable but have less than 1,000 viral copies per milliliter, the chance of transmission is “zero or negligible”.

“Gamechanger”

“The brief is a gamechanger for equitable scale-up of viral load testing and clear messaging about transmission risk,” Bruce Richman, executive director of the Prevention Access Campaign, told POZ. “This is the first time a global health institution has recommended that health care providers use and reinforce ‘zero risk’ to communicate U=U. There’s no room for ambiguity with ‘zero’!”

HIV treatment is recognized as one of the main reasons why HIV transmission rates are falling around the world. UNAIDS is encouraging all countries to reduce HIV transmission by 90% by 2030 (compared to 2010 figures). Some countries in Western Europe, including the UK, are on course to hit this target. The US, as yet, continues to lag behind.

Inner Sydney reduces HIV transmission by 88%

This week, the district of Inner Sydney revealed it had managed to reduce HIV infections by 88% since 2010. The area is a gay hotspot. It’s a remarkable achievement for the area that used to have the highest rate of HIV transmission in the country. The drop was been credited to high rates of HIV testing, getting people on to treatment to reduce viral loads, and PrEP use.

AFP says Inner Sydney reported only 11 new cases of HIV last year. Andrew Grulich, an epidemiologist at the University of New South Wales, told AFP, this was “an extraordinarily small number of infections for what was the heart of the Australian HIV epidemic.” He cautioned that other areas of Sydney did not show the same dramatic falls and more work continues to be done to replicate these results elsewhere.