In February 2016, the Prevention Access Campaign released the Undetectable = Untransmissable (U=U) statement. This was based on accumulating research from the early 2000s. In the context of three major studies published in the last two years, over 450 organisations from more than 65 countries have now endorsed the statement. These include the Centers for Disease Control and Prevention (CDC), the International AIDS Society (IAS) and the British HIV Association (BHIVA).
These studies provide robust evidence that an individual living with HIV who is consistently take ART daily as prescribed and achieve and maintain an undetectable viral load treatment and has an undetectable viral load, has a negligible risk of transmitting HIV to their sexual partner. The U=U movement has gained significant global support and is helping to eliminate HIV related stigma and improving the lives of people living with HIV.
ASHM endorses Undetectable = Untransmittable by joining Dr Tony Fauci from NIH, the United States CDC and hundreds of other community partners in an unprecedented opportunity to improve the lives of people living with HIV and to dismantle HIV stigma. This message has far-reaching public health implications for engaging HIV positive people within each stage of the HIV treatment cascade and for expanded access to treatment and care.
As the peak body representing the health workforce in blood borne viruses and sexual health – ASHM will be working in collaboration with its community, clinical and research partners to support the health workforce with training and resources to enhance their ability to convey what U=U means and the strength of the science that underpins the U=U campaign. This will be important for all people living with HIV, but especially those who are newly diagnosed, or who fear being tested for HIV. Ultimately it is a scientific and clinical imperative for health workers to promote U=U in their practice: It presents an important and powerful message encouraging individuals towards a more positive attitude towards their sexual and mental health and overall improvement in their quality of life and for those around them.
Please click here to access Undetectable = Untransmittable: A guide for clinicians
The key findings of the three studies are as follows:
From 2005, 1,763 sero-discordant couples (heterosexual and same-sex male couples) from nine countries were enrolled. The HIV positive partner was randomised to early or delayed antiretroviral treatment (ART). The 2011 interim analysis reported that 39 HIV-negative partners had acquired HIV and that 28 of these were phylogenetically linked (HIV acquired from their partner). Of the 28, only one occurred in the early treatment group (viral load not yet undetectable). All subjects were then offered HIV treatment and underwent follow up until 2015. The final data published in September 2016 reported 78 new infections, of which 72 were phylogenetically linked to a source partner. 46 were linked to the HIV-positive partner in the study and eight occurred after the positive partner commenced antiretroviral therapy. Of these final eight, four occurred before virological suppression was achieved, while the remaining 4 occurred in the context of treatment failure.
In summary, no participants with an undetectable viral load transmitted HIV to their sexual partner during the study.
Published in July 2016, the PARTNER study observed 1166 heterosexual/same sex male HIV-sero-discordant couples from 14 European countries across Europe with more than 58,000 episodes of condomless anal/vaginal intercourse. 11 HIV-negative partners acquired HIV but no transmissions were linked.
The Opposites Attract Study followed 358 sero-discordant male couples from Australia, Thailand and Brazil from early 2012 to December 2016. 343 couples attended at least one follow-up visit by the end of the study and participated in the study for an average time of just over 18 months. A total of 591 couple-years of follow-up were included in the analysis. Over 12,000 acts of condomless anal sex were reported, where the HIV negative partner was not taking Pre Exposure Prophylaxis (PrEP). Three new HIV infections occurred but there were no linked infections.
Between the Partner study and the Opposites Attract study, there have now been a combined 34,911 episodes of condomless anal sex reported in male couples when the HIV-positive partner had an undetectable viral load and the HIV-negative partner was not taking PrEP.