Living with HIV: viral suppression prevents transmission

  • Rodger AJ et al
  • The Lancet
  • 3 May 2019

  • International Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • There is 0 risk of transmitting HIV through condomless sex in the context of virally suppressive (HIV-1 RNA viral load [VL]
  • Data support U=U (undetectable equals untransmittable) and universal "test and treat" frameworks.

Why this matters

  • Prioritize early screening, diagnosis, coupled with ART initiation and regular support.
  • Monitor frequently to ensure HIV viral load suppression and promote ART adherence.

Key results

  • 782 couples; median follow-up, 2.0 (interquartile range [IQR], 1.1-3.5) years.
  • Median age, 38 (IQR, 31-45) and 40 (IQR, 33-46) years in HIV+ and HIV partners, respectively.
  • Condomless sex practiced for median 1.0 (IQR, 0.4-2.9) years.
  • VL
  • 92% of couple-years had ART adherence >90%.
  • Estimated transmission rate with 1 virally suppressed partner=0 (upper 95% CI limit, 0.23/100 couple-years).
  • No transmission linked with presence of a sexually transmitted infection.

Study design

  • Phase 2, observational PARTNER extension trial (PARTNER2) estimating transmission risk for condomless anal sex between serodifferent men with suppressive ART from September 2010 to July 2017 vs heterosexual couples (PARTNER1).
  • Funding: National Institute for Health Research.

Limitations

  • Nongeneralizable to couples in new partnerships.
  • Limited couple-years of follow-up during initial ART.

Please confirm your acceptance

To gain full access to GPnotebook please confirm:

By submitting here you confirm that you have accepted Terms of Use and Privacy Policy of GPnotebook.

Submit