Many health organizations recognize that undetectable means untransmittable (U=U). This means that if a person has HIV but is on treatment and undiagnosed, the risk that they can transmit it is zero.
The World Health Organization reaffirms this message… but it goes further.
World Health Organization a Policy brief To coincide with the International AIDS Society’s HIV Science Conference held this week in Brisbane, Australia. The brief does not simply state that the risk of transmission is zero if a person has an unknown viral load. Subsequently, people a Suppressed but recognizable Viral load has “zero or negligible risk” of being sexually transmitted.
What does “suppressed but detectable” mean?
WHO Policy Brief “There are three key categories for HIV viral load measurements: unsuppressed (greater 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 people with an undetectable viral load cannot pass the virus. this week, The Lancet Posted by a A systematic review Concerns about contagion in “low-level” viral loads. That’s less than 1,000 viral loads.
The analyzed study included 7,762 serodiscordant couples in 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 occur when an HIV-positive person has a viral load of more than 10,000.
In those two isolated cases, 50 days or more elapsed between viral load testing and transmission. Therefore, their viral load may be different during transmission.
The authors concluded, “With viral loads below 1,000 copies per milliliter, the risk of sexually transmitted HIV is virtually zero. These data provide a strong opportunity to reduce HIV and promote ART adherence.
The World Health Organization supports this message. It says, “People who have HIV in their bloodstream and have an undetectable viral load … have zero chance of passing HIV to their sexual partner(s).” It goes on to say, “People with HIV in their bloodstream who have a suppressed but detectable viral load and who take medication as prescribed have zero or negligible risk of transmitting HIV to their sexual partner(s).
This will be comforting to many serodiscordant couples who may be concerned about a small increase in viral load. Even if you are not undetectable, but have less than 1,000 copies of the virus per million, the chance of transmission is “zero or negligible.”
“Game Changer”
“The short viral load test will help promote fairness and communicate a clear message about the risk of transmission,” said Bruce Richman, executive director of the Prevention Access Campaign. POZ. “This is the first time that a global health institute has recommended that healthcare providers use and reinforce ‘zero risk’ to create a U=U relationship. There is no ambiguity about ‘zero’!”
HIV treatment is recognized as one of the reasons why HIV transmission rates are decreasing worldwide. UNAIDS is encouraging all countries to reduce HIV prevalence by 90 percent by 2030 (compared to 2010 figures). Some countries in Western Europe, including the United Kingdom, are preparing to hit this target. The US has so far lagged behind.
Inner Sydney reduces HIV prevalence by 88%.
This week, the inner Sydney district announced an 88% reduction in HIV infections since 2010. The area is a gay hotspot. This is a remarkable achievement for an area with the highest HIV prevalence in the country. It has been attributed to higher rates of HIV testing, getting people into treatment to reduce viral loads, and significantly reducing PrEP use.
AFP Inner Sydney reported just 11 new HIV cases last year. Andrew Grulich, an epidemiologist at the University of New South Wales, told AFP that this was “a very small number of infections that are part of Australia’s HIV epidemic”. He cautioned that other areas of Sydney have not shown the same dramatic decline and further work will continue to replicate these results elsewhere.