A systematic review of eight studies of more than 7700 couples with inconsistent serotypes in 25 countries found that:People living with HIV who have a viral load of less than 1000 milliliters have almost zero risk of transmitting the virus to their sexual partners. Previous studies have failed to confirm that there is no risk of transmission for more than 200 milliliters.
The systematic review also consolidates and strengthens previous research, which finds,:When a person living with HIV has an undetectable viral load, there is zero risk of transmitting the virus to a sexual partner.
Of the more than 320 cases of sexual transmission recorded in the study, only two involved partners with a viral load of less than 1000 milliliters. In both cases, viral load testing was performed at least 50 days prior to transmission.
At least 80% of transmissions involve people living with HIV with a viral load greater than 10,000 ml copies.
These findings are published in conjunction with a new WHO policy brief that provides up-to-date guidance on HIV** surveillance, accompanied by supporting information on the risk of transmission.
Together, this new research and policy brief drive global efforts to expand antiretroviral** (ART) for all people living with HIV and HIVAchieve undetectable viral loads.
Emphasis will be placed on the willDecriminalization of HIVwithReduce stigma and discrimination against people living with HIVThe importance of the matter.
According to an analysis published in The Lancet,People living with HIV maintain low but still detectable levels of the virus and adhere to antiretroviral**, with almost zero risk of transmitting the virus to their sexual partners. The findings of this study will be presented at an official satellite conference ahead of the 12th International AIDS Society AIDS Scientific Conference (IAS 2023).
The results of the systematic review show that with a viral load of less than 1000 copies per milliliter of blood, the risk of sexual transmission of HIV is almost zero – this is often referred to as:Viral load is suppressed。The systematic review also confirms that:People living with HIV who have an undetectable viral load (undetectable with the testing methods used) have zero risk of transmitting HIV to their sexual partners.
The World Health Organization (WHO), together with the study**, has published a new policy brief that provides policymakers, public health professionals and people living with HIV with up-to-date guidance on STT prevention and viral load testing. This guidance aims to further prevent the spread of HIV and ultimately support global efforts to achieve undetectable viral loads and prevent further transmission of the virus to their sexual partners and children through antiretroviral** for all people living with HIV.
Previous studies have shown that people living with HIV who have a viral load of less than 200 copies of milliliters have zero risk of sexually transmitting the virus. However, so farThe risk of transmission with a viral load between 200 and 1000 copies ml is not well defined.
The authors filled this knowledge gap by searching databases for all studies published between January 2000 and November 2022 on HIV sexual transmission at different viral loads. The systematic review included a total of eight studies that provided data on 7762 seronon-congruent couples from 25 countries, one of whom was living with HIV.
Laura Blooyles, MD, lead author of Global Health Impact (Atlanta, USA), said: "These findings are important because they show that it is extremely rare for people who maintain low levels of HIV to transmit it to their sexual partners. Crucially, this conclusion can facilitate the expansion of more feasible alternative viral load detection modalities in resource-limited settings. Improving access to routine viral load testing can ultimately help people living with HIV live healthier lives and reduce the spread of the virus. ”
Taking HIV medication daily – antiretroviral (ART) – can reduce the amount of virus in the body, thereby preserving immune function, reducing virus-related morbidity and mortality, and helping to reduce HIV progression. Without antiretroviral**, a person living with HIV may have a viral load of more than 30,000 to 500,000 milliliters, depending on the stage of infection.
While the use of laboratory-based plasma sample methods provides the most sensitive viral load test results, such testing is not feasible in many parts of the world. However,The new findings support the wider use of simpler testing methods, such as the use of dried blood spot samplesBecause they are effective in classifying viral load for necessary clinical decisions.
Of the 323 cases of HIV sexual transmission detected in all eight studies, only two involved partners with viral loads of less than 1000 milliliters. In both cases, viral load testing was performed at least 50 days prior to transmission, suggesting that an individual's viral load may have risen in the period following the test. At least 80% of studies that provided the full viral load of HIV-infected partners involved a viral load greater than 10,000 ml.
"The ultimate goal of antiretroviral** administration to people living with HIV is to maintain an undetectable viral load, which will improve their own health and prevent the transmission of the virus to their sexual partners and children," said Dr Lara Vojnov of WHO. But these new findings are also important because they show that the risk of sexually transmitted HIV is almost zero in the case of a low viral load. This presents a powerful opportunity to help destigmatize HIV, promote the benefits of upholding antiretroviral** and support people living with HIV. ”
The authors acknowledge that their study has some limitations. Some of the data analysed were imprecise due to differences in the definition of "low viral load" in different studies, the timing and frequency of viral load testing, and patient follow-up. Today, HIV** is recommended for all people living with HIV, and given the extremely low number of transmissions, a very large sample size is required to make a more precise estimate.
In addition,These findings do not apply to mother-to-child transmission of HIV, because the duration and intensity of exposure – during pregnancy, childbirth, and lactation – are much higher. There are also differences in the way the virus is transmitted from mother to child compared to sexually transmitted virus. Ensuring that pregnant and lactating women have undetectable viral loads throughout exposure is key to preventing new HIV infections in children.
*: True focus.