The First Benefit Of Optimal ARV Adherence Is Total Durable Suppression of HIV Virus

We encourage our beneficiaries living with HIV to take their medications regularly without fail. We also encourage them to protect against any other STIs when they are sexually active. While stressing all this we also stress, the need for feeding well, proper housing and engaging in some form of activity or income generation. We came across an article which links viral suppression to no transmission. Although, in the studies having other STIs is shown not to be a risk for HIV transmission as long viral suppression is ensured. There is global consensus pointing to the fact that an undetectable viral load brought about by optimal ARV adherence is associated with an effectively zero chance of transmission. Who says that? You may ask.

PARTNER2 study documented 75,000 condom-less anal sex acts between mixed-HIV-status men; Opposites Attract had 12,000. PARTNER2 study was the prospective observational study in which zero transmissions were documented between study partners when the HIV-positive partner had a fully suppressed viral load, even after nearly 75,000 condom-less anal sex acts.

Three major studies have followed mixed-HIV-status couples over time in an effort to assess the link ARV treatment has on prevention of transmission. None have seen the HIV-positive participants transmit the virus to their study partners when they had an undetectable viral load. The HPTN 052 study included only heterosexual couples, while the PARTNER study included both male-female and male-male couples; the Opposites Attract study, called PARTNER2, focused exclusively on male-male couples. It included 343 male-male couples in which one partner was HIV positive and the other was HIV negative. The men were recruited at 13 clinics in Australia (from May 2012 to March 2016), one in Brazil (from May 2014 to March 2016) and one in Thailand (also from May 2014 to March 2016).

According to Andrew Grulich, head of the Kirby Institute at UNSW Sydney’s HIV Epidemiology and Prevention Program and chief investigator on the study, was much more emphatic in a press release, stating, “These results form a significant part of the evidence base for the international community-led Undetectable=Untransmissible, or U=U campaign, which highlights the fact that people living with HIV can now live long and healthy lives, with effectively zero chance of sexually transmitting the virus to others, provided their viral load is undetectable due to effective ART."  For more on the study see: HIV treatment-as-prevention is effective in homosexual male couples, study finds. Virally suppressing HIV is so important if HIV is not to be transmitted. 

According to the authors of the HPTN 052 study, “the most appropriate policy and community education response might be to suggest use of condoms or PrEP in the first six months [of ARV treatment for the HIV-positive partner in a mixed-HV-status couple] and until viral suppression is certain. After this period, viral suppression alone is likely to be sufficient [to prevent HIV transmission]. They continued saying, “HIV-negative men in non-monogamous serodiscordant couples should be considered for PrEP initiation, given the high HIV incidence among these men and that [condom-less anal sex] with outside partners was not uncommon.”

The take back home points are:

1. Optimal ARV adherence

2. Regular check up

3. In discordant partners, first six months before suppression use of condoms and continued ARVs or PrEP is required