What Does This Mean For Me
‘Undetectable equals Untransmittable’ has been a life-changing finding for many people living with HIV. It means that if you are on effective treatment with an undetectable viral load, you do not have to worry about passing on HIV through sex, even if you do not use a condom.
Basic information on undetectable viral load
This has helped many people living with HIV have more fulfilling sex lives and less anxiety around sex.
Knowing that ‘Undetectable equals Untransmittable’ is especially useful for people wishing to have a child. Couples in which one person has undetectable HIV and the other is HIV negative can have unprotected sex in order to conceive.
However, the law on HIV may not have caught up with the science. In some countries, condomless sex without disclosing your HIV status is a criminal offence, regardless of the likelihood of HIV transmission. For information on specific countries, visit our page on criminalisation laws around the world.
Hiv During Pregnancy And Childbirth
Women living with HIV who are on treatment and have a stable undetectable viral load are extremely unlikely to transmit HIV to their baby during pregnancy and childbirth. There is a 1 in 1000 chance of transmitting HIV to the baby during pregnancy and delivery, when a woman is on antiretroviral treatment and has a viral load below 50 copies/ml .
HIV-positive women who are on treatment and have stable undetectable viral load, have a 1-2% chance of transmitting HIV to their baby if they breastfeed for 12 months.
So, although it is unlikely that a woman will transmit HIV to her baby when breastfeeding it is currently advised not to breastfeed.
Broadly Neutralizing Antibodies Show Promise
The discovery of rare individuals who make anti-HIV antibodies that can be effective against up to 80% of circulating strains, however, has boosted prospects for antibody treatments for HIV.
These broadly neutralizing antibodies, or bnAbs, have seen impressive results. Monkeystudies have found that a single administration of bnAbs can prevent infection from SHIV, the nonhuman primate version of HIV. One study found that two broadly neutralizing antibodies were able to reduce viral loads to undetectable levels in infected monkeys.
In people, one study administering two bnAbs also saw suppression of HIV replication and nearly undetectable viral loads. One early-phase clinical trial in 2021 showed that one bnAb could potentially offer protection against HIV infection.
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Does Being Durably Undetectable Mean That The Virus Has Left My Body
Even when viral load is undetectable, HIV is still present in the body. The virus lies dormant inside a small number of cells in the body called viral reservoirs. When therapy is halted by missing doses, taking a treatment holiday or stopping treatment, the virus emerges and begins to multiply, becoming detectable in the blood again. This newly reproducing virus is infectious. It is essential to take every pill every day as directed to achieve and maintain a durably undetectable status.
Getting Pregnant When Both Parents Have Hiv
Seroconcordant couples , can have an HIV-negative child. If both partners are on treatment, the risk of either partner transmitting HIV to their baby is almost zero.
If you are a seroconcordant couple and you are thinking of becoming pregnant it is important to speak with an obstetrician and an HIV specialist to minimise the risk of transmitting HIV to your baby.
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Testing Positive For Hiv During Pregnancy
HIV testing of women in early pregnancy is now routine in Australia. Testing should be done with your consent and is offered during your first set of antenatal tests.
If you receive a positive test result, be reassured that many people with HIV live a full and active life. The risk of HIV transmission to your child is very low, given appropriate treatment.
Support is available through:
What Will Happen If I Skip My Arv For 2 Days
Missing doses of HIV medicines can reduce their usefulness and increase the possibility of developing drug resistance, which makes certain HIV drugs lose their effectiveness. If you realize you have missed a dose, go ahead and take the medication as soon as you can, then take the next dose at your usual scheduled time.
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How Variable Is An Undetectable Viral Load Can This Change Over Time
HIV specialists have decades of experience managing antiretroviral therapy and are confident that you can remain uninfectious as long as you:
- take your medication every day as prescribed, and
- have your viral load checked regularly.
The presence of other sexually transmitted infections can potentially affect viral load, but in the PARTNER study there were no HIV transmissions even when other STIs were present. Those results held through the PARTNER 2 trial as well.
It is however important to remember that HIV treatment can only be successful if you have access to it and are taking it as prescribed.
How Is Hiv Transmitted From Mother To Child During Pregnancy
If you are a pregnant woman living with HIV there are a number of ways that HIV might be passed on to your baby. HIV in your blood could pass into your babys body. This is most likely to happen in the last few weeks of pregnancy, during labour, or delivery. Breastfeeding your baby can also transmit HIV, because HIV is in your breastmilk.
There is a 15 to 45% chance of passing HIV on to your baby if neither of you take HIV treatment.
However, taking the correct treatment during your pregnancy and while you breastfeed can virtually eliminate this risk.
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Where To Get Help
- , Centers for Disease Control and Prevention.
- Palasanthiran P, Starr M, Jones C, Giles M 2014, Management of perinatal infections, Australasian Society for Infectious Diseases , Sydney.
- Perinatal exposure to HIV among children born in Australia, 19822006, Medical Journal of Australia, vol. 190, no. 8, pp. 416420.
- Perinatal exposure to HIV in Australia, 1982-1994, Medical Journal of Australia, vol. 166, no. 2, pp. 7780.
- Variable uptake of recommended interventions to reduce mother-to-child transmission of HIV in Australia, 1982-2005, Medical Journal of Australia, vol. 189, no. 3, pp. 151154.
- Lindsay, M 2014, Women with HIV infection on antiretroviral therapy with low viral loads can safely opt for vaginal delivery in the absence of obstetrical risk factors, Evidenced-Based Medicine, vol 19, no. 4, p. 159.
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- HIV can pass from mother to baby during pregnancy or birth or via breastmilk.
- Due to treatment advances, mother to child transmission of HIV is very rare in Australia.
- With medical support, the HIV transmission rate from mother with HIV taking antiretroviral treatment to their unborn child is 1% or less in Australia.
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Effective Treatments Can Reduce Hiv Transmission
When someone with HIV is on antiretroviral treatment and consistently has very low levels of virus they are not infectious and cannot sexually transmit the virus.
This may be true for sexual transmission during pregnancy, but researchers are still gathering more evidence before they can be confident it is true for transmission during pregnancy, labour and delivery, and during breastfeeding.
New preventative medications Pre-exposure prophylaxis and post-exposure prophylaxis can be taken by HIV-negative people who are at risk of getting HIV.
As long as the HIV-positive partner maintains a stable undetectable viral load and these medications are taken strictly as prescribed, HIV transmission to a negative partner is not possible.
Speak to your treating doctor if you would like to explore these newer prevention drugs.
What Does U=u Mean For Me If I Have Hiv
It means that if you are undetectable and stay on HIV treatment, you are likely to be much healthier than if you were not on treatment and also that you no longer need to be afraid of transmitting HIV to others during sex. As stated in the NAM aidsmap resource Undetectable viral load and transmission information for people with HIV, If you have sexual partners who are not living with HIV, explaining U=U to them is likely to be mutually beneficial. If you had previously relied on other means of preventing HIV transmission , you may jointly decide that these methods are no longer necessary because of U=U. It is important to remember that while an undetectable viral load will protect your partners from your HIV, it does not protect them or you from other sexually transmitted infections or prevent unwanted pregnancy. Condoms are highly effective at preventing STIs. Condoms and other birth control options may be considered to prevent pregnancy as well.
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What Does Undetectable Mean
The word undetectable is the lowest limit of the laboratory tests used to measure HIV viral load. Some viral load tests are very sensitive and can find or detect HIV in a sample of blood when there are only 20 copies of the virus per milliliter . Other viral load tests need up to 200 copies per mL of blood to detect any HIV. In the context of U=U, it does not matter which type of test your doctor uses to measure your viral load. As long as your viral load remains below 200 copies/mL, your risk of sexually transmitting HIV is negligible.
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More Sensitive Viral Load Testing
In NSW we now have more sensitive viral load testing, which means laboratories across the state can detect small amounts of the virus as low as 20 copies/mL. For HIV positive guys this means that they may see some change from their previous viral load readings from below 20 copies/mL a new, potentially higher number. This should not be a cause for concern as any viral load of 200 copies/mL or less is still considered undetectable. A person with this level of viral suppression cannot transmit HIV to their partners, however if you still feel concerned, we recommend speaking with your doctor.
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If My Viral Load Is Undetectable Can I Transmit Hiv To Other People
Im very happy to say that we know the answer to this. If you are undetectable, and have been on HIV medications for at least six months, and you continue that treatment, the risk of transmitting HIV is effectively zero.
This finding has been well-established over the last six to seven years . After studying thousands of couples, over many years, research has shown that if an HIV-positive person is on effective HIV medications for at least six months, is undetectable, and stays on their HIV medications, they will not transmit HIV to other people.
After I Begin Hiv Treatment How Long Does It Take For The Risk Of Sexually Transmitting Hiv To Become Effectively Zero
There is effectively no risk of sexual transmission of HIV when the partner living with HIV has achieved an undetectable viral load and then maintained it for at least six months. Most people living with HIV who start taking antiretroviral therapy daily as prescribed achieve an undetectable viral load within one to six months after beginning treatment.
A persons viral load is considered durably undetectable when all viral load test results are undetectable for at least six months after their first undetectable test result. This means that most people will need to be on treatment for 7 to 12 months to have a durably undetectable viral load. It is essential to take every pill every day to maintain durably undetectable status.
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Counseling Individuals With Hiv About U=u
Lead authors: Oni Blackstock, MD, MHS Julie Myers, MD, MPH Paul Kobrak, PhD and Demetre Daskalakis, MD, MPH with the Medical Care Criteria Committee updated December 2020
Care providers should inform all patients of the following: People who keep their HIV viral load at an undetectable level by consistently taking HIV medications will not pass HIV to others through sex.
Sharing this message with all patients can help accomplish the following:
- Diminish stigma associated with having HIV.
- Reduce barriers to HIV testing and treatment.
- Increase interest in starting and staying on antiretroviral therapy .
- Improve self-esteem by removing the fear of being contagious.
- Support healthy sexuality regardless of HIV status.
- Reduce sex partners concerns.
Providing this message is important regardless of the patients current sexual activity, as many people living with HIV maintain celibacy because of the fear and anticipatory guilt of potentially transmitting HIV.
Encourage patients newly diagnosed with HIV and those previously diagnosed but not taking ART to immediately start treatment.
Explain that doing so will help them avoid damage to their body and immune system and will prevent transmission of HIV to their sex partners.
Provide the following information about U=U to patients :
Counsel patients to share information about the research on U=U as follows :
Advise patients that they can share the following personal information with current or potential sex partners:
Reference
What Is Effective Treatment
We are using the term effective treatment to mean that someone is on treatment, taking it as prescribed and has an undetectable viral load. In the UK this is usually classed as a viral load below 20 copies/ml.
The Partners PrEP study found that there remains a transmission risk within the first six months of treatment as the HIV positive partners viral load takes time to come down.
Therefore effective treatment means someone has been taking it as prescribed for at least six months and has an undetectable viral load.
Over 90% of people diagnosed with HIV in the UK are on effective treatment and undetectable, and therefore are not infectious .
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Why Do Some People Have Detectable Viral Loads
Access to adequate healthcare, treatment, and viral load testing are serious barriers in many parts of the world. Some people who have access to treatment may choose not to be treated or may not be ready to start. Others start treatment but have challenges with taking their medication regularly for a variety of reasons such as stigma, mental health challenges, substance abuse, unstable housing, difficulty paying for medications, hostile environments, drug resistance, and/or intolerable side effects. Additionally, second and third line ART options may not be available to all.
Some people with low but detectable viral loads also cannot transmit HIV. For instance, someone who is virally suppressed and still detectable cannot transmit HIV. For people living with HIV who are not virally suppressed or undetectable, there are highly effective options including condoms, and in some parts of the world, PrEP, to prevent HIV. Condoms and PrEP can be used individually or in combination to prevent HIV. Everyone living with HIV regardless of their viral load status has the right to full and healthy social, sexual, and reproductive lives. U=U is a call to action to ensure access to treatment, care, and services for all people living with HIV.
Does U=u Apply To Transmission Through Needle Sharing
U=U does not apply to HIV transmission through sharing syringes or other injection equipment needle sharing. There is not yet enough research to draw a conclusion. There is some evidence from a 2013 study in Bangkok, Thailand, that treatment reduces the chance of transmission via needle sharing, but more research is needed. Harm reduction services are critical to supporting the health of injection drug users and preventing HIV transmission. For help regarding addiction and treatment, please visit the link below.
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Do I Still Need To Worry About Other Sexually Transmitted Infections
Neither HIV treatment nor PrEP prevents other sexually transmitted infections, or STIs.
Ways to reduce the risk of STIs include having both partners tested, limiting the number of sexual partners and using condoms. Vaccines are available to prevent some STIs, including hepatitis B and human papillomavirus .
What About Sexually Transmitted Infections
It is important to remember that while HIV treatment will protect your partners from your HIV, it does not protect them or you from other sexually transmitted infections . For this reason, regular sexual health check-ups are recommended. Using condoms will help prevent STIs.
Another concern is whether having a STI could lead to an increase in viral load. This does happen to people with HIV who are not taking treatment: for instance, syphilis can double your viral load. HIV-negative partners are also more likely to get HIV if they have an STI.
But it is not the case for people taking HIV treatment who have an undetectable viral load. In the PARTNER and Opposites Attract studies, there was not a single HIV transmission even though many people had STIs.
If you maintain good adherence to HIV treatment, catching an STI will not raise your viral load from undetectable to detectable. Effective treatment prevents sexual transmission of HIV even if there are other STIs present.
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