According to a meta-analysis of several studies, people living with HIV who are on antiretroviral therapy and who have low levels of the virus (but still detectable by tests) are at almost no risk of passing it on to their sexual partners. The research results are currently being presented at the 12And International AIDS Society Conference on HIV Science.
Emerging public health data offer an opportunity to destigmatize HIV and promote adherence to antiretroviral therapy, which significantly reduces viral load. On the one hand, the analysis published in The Lancet confirms that the risk of transmitting the virus to sexual partners is zero when people living with HIV have an undetectable viral load (not detected by the test being used). On the other hand, a review of eight studies involving more than 7,700 couples (in which one partner is HIV positive) finds that people living with HIV and whose viral load is less than 1,000 virus copies per milliliter of blood have almost no risk of transmitting the virus to their sexual partners.
The results of the study are currently presented at 12And conference of the International AIDS Society on the Science of HIV, which will take place from 23 to 26 July 2023. In parallel, a new document from the WHO (World Health Organization) provides updated advice for the prevention of sexual transmission of HIV, based on of this research.
A reassessment of the risk of HIV transmission
Previous studies on the subject have shown that people whose HIV viral load is less than 200 copies per ml of blood are at no risk of sexually transmitting the virus. But the implications of a viral load between 200 and 1,000 copies per mL were less clear.
The analysis of four prospective studies highlighted 323 cases of HIV transmission, none of which from patients on antiretroviral therapy and with low viral load. The researchers identified only two cases of transmission from a patient diagnosed with a viral load of less than 1,000 copies per mL. However, in these two cases viral load testing was performed at least 50 days before transmission, suggesting that the individuals’ viral load may have subsequently increased.
The study also shows that at least 80% of transmissions involved an HIV-positive partner whose viral load was greater than 10,000 copies per mL. You should know that without treatment, people living with HIV can have a viral load of between 30,000 and over 500,000 copies per mL.
Dr. Lara Vojnov, co-author of the study, She said : “ The ultimate goal of antiretroviral therapy for people living with HIV is to maintain an undetectable viral load, but these new findings are also important. This is a unique opportunity to help destigmatize HIV, promote the benefits of treatment and support people living with HIV. The authors also highlight the need to scale up viral load testing in all settings where people living with the disease are on antiretroviral therapy.
A few limitations should be noted. For example, some data was inaccurate due to study-to-study variation. Given the relatively low number of transmissions (because HIV treatment is recommended for all HIV-positive people), very large sample sizes would be needed to obtain more precise estimates.
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