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