17 November 2020

Australia first to say undetectable HIV is untransmissible HIV

Clinical Communicable Disease

The data is clear: undetectable HIV is untransmissible HIV. 

This is the world-first message coming from Australia’s latest national guidelines on HIV prevention. 

“It’s incredible,” said Dr Vincent Cornelisse, co-author of the guidelines and clinical advisor at Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM). 

“We are now really at a point where people living with HIV who engage in treatment can expect to live just as long as anyone else,” he said. “And now we can also, with confidence, say that it shouldn’t need to affect their relationships.” 

While the campaign, sometimes written as U=U, has gained traction in recent years, guidelines have hedged the message by stating that a person with an undetectable viral load has  “effectively” no risk of transmitting the disease to their partner. 

But now ASHM have issued the first national guidelines that unequivocally back U=U. 

The guidelines, released Tuesday at the joint Australasian HIV&AIDS and Sexual Health Conferences, were formed amid a growing body of evidence indicating that patients who take their prescribed HIV medication and attain an undetectable viral load don’t transmit the virus to their HIV-negative partner. 

“The data has become more convincing,” said Dr Cornelisse, who is a sexual health physician at Kirketon Road Centre in Kings Cross, Sydney. 

Long-term findings from the PARTNER and Opposites Attract studies have provided clear evidence that HIV cannot be transmitted sexually from someone who is on treatment and who has an undetectable viral load, he said. Durable viral suppression is defined as fewer than 200 HIV RNA copies per mL of blood. 

Professor Basil Donovan, head of the Sexual Health Program at the Kirby Institute, said he was confident in the new advice, and believed it would also help clinicians relax around patients with HIV. 

“It’s obvious that the latest generation of drugs are extremely forgiving,” he told The Medical Republic. “So even if someone’s pretty chaotic, taking most of their medications and not necessarily all of them will still suppress the virus.”  

Dr Cornelisse stressed that people living with HIV, and their partners, needed concrete advice that didn’t leave room for doubt. He and his colleagues urged clinicians to educate partners and others in affected populations, to reduce the burden on patients themselves. 

“There is ongoing fear and stigma,” said Dr Cornelisse. “And the risk of transmission to partners is at the front of mind for many people who are living with HIV.” 

HIV has a powerful influence on people’s mental wellbeing, even when their physical health is fine, he said. 

“Just knowing that HIV does not need to have that presence in the relationship has the potential to allow people to have much healthier relationships.” 

While Australia is the first nation to have guidelines with such strong language, New York City’s health department has similarly backed a clear-cut U=U message.

ASHM hoped that this good news would also encourage people with HIV to start antiretroviral therapy as soon as possible after diagnosis. 

For more information, visit https://www.ashm.org.au/HIV/UequalsU/ 

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Samuel Komakech
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Samuel Komakech
4 months 24 days ago

Professor Basil Donovan, head of the Sexual Health Program at the Kirby Institute, said he was confident in the new advice, and believed it would also help clinicians relax around patients with HIV.
The discussion presented looks at partner transmission risk but does the evidence imply the risk is equally mitigated in iatrogenic instances? Should we then stop flagging patients in this category as high risk for transmission in the healthcare setting? Though it is good news, certainly further studies to make certain the evidence stands true in all situations is warranted before clinicians change their practice.

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