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.
How Often Should Viral Load Testing Be Done
According to the United States Health and Human Services clinical HIV guidelines, patients on a stable, suppressive ARV regimen, viral load should be repeated every 3 to 4 months or as clinically indicated to confirm continuous viral suppression. Clinicians may extend the interval to 6 months for adherent patients whose viral load has been suppressed for more than 2 years and whose clinical and immunologic status is stable. In high-resource countries, providers are increasingly conducting viral load testing on an annual basis.
The World Health Organization guidelines, most often followed in low and middle income countries, however, note on page 148, Routine viral load monitoring for early detection of treatment failure: obtain and review result by 6 months after ART initiation, 12 months after ART initiation and yearly thereafter.
Are U=u And Treatment As Prevention The Same
U=U and TasP are one and the same, just different ways of stating the same concept about people living with HIV who are on effective ART. TasP has been used widely in medical and public health literature for years and means what it sounds like: taking ART and staying virally suppressed stops people from transmitting HIV, meaning it also acts as a form of HIV prevention. Both TasP and U=U are based on the important goal of having everyone with HIV be aware of their status so they can take ART. ART not only improves the health of PLWH, but also reduces the virus in a persons cells to the point of being “undetectable”. Viral load measures the effectiveness of ART. When a person is undetectable, they do not transmit HIV sexually. U=U has been taken up by the broader HIV-affected community to spread awareness that if you are undetectable, you will not transmit HIV. U=U sends a hopeful, empowering message and addresses the stigma often associated with living with HIV and an HIV/AIDS diagnosis.
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Ethics Approval And Consent To Participate
All study procedures were conducted in compliance with the relevant national laws and international regulatory requirements. Written informed consent was obtained from all study participants prior to any protocol-specified procedures being conducted. The study protocol, informed consent forms, and other study instruments administered to participants were reviewed and approved by the Joint Clinical Research Centre Institutional Review Board in Uganda the Uganda National Council for Science and Technology , Johns Hopkins University and University of California San Francisco Ethics committees prior to participant enrolment or study procedures.
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.
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Studies Prove Hiv Therapy Can Erase The Risk Of Infecting Others
Ever since the human immunodeficiency virus was first discovered in 1983, scientists have worked ceaselessly to find ways to prevent the further spread of the disease. Some of the interventions, like condoms, are effective but far from foolproof. Others, like pre-exposure prophylaxis , are over 90% effective but have been poorly embraced by many high-risk groups, including African Americans. It was only in 2019 that scientists finally revealed the one intervention that can effectively reduce the risk of HIV to zero: an undetectable viral load.
The strategy, referred to by public health officials as “Undetectable = Untransmittable” , is based on evidence that antiretroviral therapy in people with HIV can altogether prevent infection if the viral load is fully suppressed.
According to research, a person with HIV cannot infect others if there is no circulating virus in semen, blood, or other bodily fluids.
It is a strategy that had been long debated prior to the release of the PARTNER 2 study 2019 and the earlier PARTNER 1 study in 2016. The landmark studies, which involved 1,570 gay and heterosexual serodiscordant couples provided what health officials declared was the first sure-fire way to prevent transmission even when condoms were not used.
Despite the definitive results, there are some limitations to the U=U strategy, namely the low rate of undetectable viral loads among Americans living with HIV.
Does U=u Apply To The Non
This page is about HIV transmission during sex.
But an undetectable viral load is also crucial for conception, pregnancy and birth. If you maintain an undetectable viral load during pregnancy, the risk of HIV being passed on to your baby is just 0.1%, or one in a thousand.
During breastfeeding, an undetectable viral load greatly reduces the risk of passing HIV on, although it does not completely eliminate this possibility. In the UK and other countries where clean water and sterilising equipment are available, bottle feeding with formula milk is the safest way to feed your baby.
If you use injection drugs and or other equipment, taking HIV treatment and having an undetectable viral load greatly reduces the risk of passing HIV on, but we dont know by how much.
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Viral Load And Hiv Transmission
A low viral load means a person is less likely to transmit HIV. But its important to note that the viral load test only measures the amount of HIV thats in the blood. An undetectable viral load doesnt mean HIV isnt present in the body.
HIV-positive people may want to consider precautions to lower the risk of HIV transmission and to reduce the transmission of other sexually transmitted infections .
Using condoms correctly and consistently when having sex is an effective STI prevention method. Check out this guide to using condoms.
Its also possible to transmit HIV to partners by sharing needles. Its never safe to share needles.
HIV-positive people may also want to consider having an open and honest discussion with their partner. They can ask their healthcare providers to explain viral load and the risks of HIV transmission.
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Do Stis Affect The Zero Risk
U=U still works if, without realising it, one or both partners has an STI.
The PARTNER study included couples where STI rates were reported, usually in the context on an open relationship. Although routine check-ups for STIs are important, with treatment if needed, there were still no HIV transmissions.
It is only when ART is not used that the risk of HIV transmission becomes higher if either partner has an STI.
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My Latest Lab Report Says < 20 Am I Still Undetectable
A full range of campaign posters are freely available for download below to help spread the word that Undetectable = Uninfectious. Alternatively if you would like us to send your business or organisation a stock of printed A3 posters along with other information leaflets and booklets, you can order them here.
Blood Sample Collection And Hiv Testing
Whole blood collected in sterile EDTA tubes was stored at room temperature. Plasma was then separated from whole blood by centrifugation within 24 h of sample collection after which plasma was transferred to sterile cryovials. In Kampala, processing and storage was done at the VL testing Laboratory while in Mityana, plasma was stored frozen at 20 °C in the Mityana Hospital Laboratory and transported to Kampala for storage and VL testing every 12 weeks on frozen icepacks in temperature-controlled cool boxes. Plasma VL testing was conducted in batches at the Infectious Disease Institute Core Lab in Mulago Hospital using COBAS Ampliprep /COBAS Taqman HIV-1 test whose lower limit of detection was 20 copies/ml. Participants in whom no viral copies were detected had repeat rapid HIV antibody testing done to confirm HIV diagnosis and if found negative, had HIV DNA PCR testing done. Undetectable viral load in this study was defined as VL count< 20 copies/ml while virological suppression was defined as VL count< 400 copies/ml.
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How Do We Know Treatment As Prevention Works
Large research studies with newer HIV medications have shown that treatment is prevention. These studies monitored thousands of male-female and male-male couples in which one partner has HIV and the other does not over several years. No HIV transmissions were observed when the HIV-positive partner was virally suppressed. This means that if you keep your viral load undetectable, there is effectively no risk of transmitting HIV to someone you have vaginal, anal, or oral sex with. Read about the scientific evidence.
Do I Still Need To Use Condoms If Im Undetectable
Some couples decide that they want to stop using condoms once they or their partner are undetectable. Its important to remember that although theres no HIV risk, being undetectable doesnt prevent you from getting or passing on other sexually transmitted infections or stop unwanted pregnancies, so you will have to use other measures to avoid these.
If you do stop using condoms, its important that both you and your partner are comfortable with the decision. It can help to talk it through with a healthcare worker first. Its recommended that you have a least two viral load tests confirming that youre undetectable before relying on this for HIV prevention. If your partner is HIV-negative they may consider using PrEP as an extra precaution.
In couples where both partners are living with HIV, its important that you are both undetectable before deciding not to use condoms. This is because if one partner has a different strain of HIV or has developed drug resistance this can be passed on if they have a detectable viral load.
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Should I Stop Using Condoms And/or Prep If Im With Someone Who Is Undetectable
PrEP and/ or condoms are not necessary to prevent HIV when the sexual partner living with HIV has an undetectable viral load. Having an undetectable viral load, using PrEP, and using condoms are all HIV prevention strategies that people can choose to use alone or in combination. We provide information about the latest science of HIV transmission so people with HIV and their partners can make informed decisions about what works for them. Some people may prefer to use several HIV prevention strategies for a variety of reasons such as to reduce transmission risk anxiety, because they have sex with more than one person, to prevent other STIs, to prevent pregnancy, or if the partner with HIV has challenges with ART adherence. Condoms, when used correctly, are the only method that helps prevent HIV, some STIs, and pregnancy.
It may take time for an HIV-negative person to trust in their partner being truly undetectable and that that will keep them safe from HIV. As the study cited below showed, it can take time, sometimes years. Partners living with HIV can see it as evidence they are not trusted, when it may be that anxiety from the HIV-negative partner is about coming to terms with new information. In the meantime, other strategies are possible including PrEP.
What Does This Mean For Reproductive Health Such As Conception Pregnancy And Breastfeeding/chestfeeding
Knowing that an undetectable viral load prevents HIV transmission through sex may be especially useful for people wishing to conceive a baby without using assisted reproduction methods. An undetectable viral load also dramatically reduces the risk of transmission during pregnancy, birth, or breastfeeding. For more information on HIV and reproductive health, such as pregnancy and breastfeeding/chestfeeding, please refer to the sources below.
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Why Isnt My Medical Provider Telling Me This Information
Unfortunately, some medical providers are not up-to-date with the current science. Others agree with the science but are concerned about 1) an increase in condomless sex among people with HIV which may result in an increase in other STIs 2) patients potential lack of understanding that maintaining an undetectable viral load requires excellent treatment adherence and monitoring and 3) if people with HIV interrupt their treatment by choice or circumstances outside of their control, their virus will likely rise to detectable levels. Some medical providers selectively choose to discuss this information only with patients and clients whom they judge are responsible rather than directly address the concerns described above through education. There is no medical or ethical justification to withhold this information. It is essential for medical providers to inform their patients about the benefits of treatment.
How Do We Know That U=u What Is The Evidence
The evidence for U=U comes from several groundbreaking research studies and clinical trials. A study called HPTN 052, a randomized control trial to find out if ART can stop transmission of HIV in sero-different couples, enrolled more than 1,700 sero-different heterosexual couples who were randomly assigned to have the HIV-positive partner either immediately start ART or delay the start of ART. Over time, results among study participants showed no linked transmissions when the index partner was suppressed.
Another study, the PARTNER Study, which was carried out at 13 sites in Europe, had specific enrollment eligibility criteria that included undetectable sero-different couples who had condom-less sex. In what were a reported 58,213 sexual encounters during this study, there were no transmissions linked to the HIV-positive partners. In the summer of 2017, at the International AIDS Conference in Paris, the results of the Opposites Attract study were reported. It studied 358 gay male sero-different couples and found no linked HIV transmissions in nearly 17,000 condom-less sexual acts.4
The findings from these three key studies show that not only does being on effective antiretroviral treatment improve the health of each person with HIV, it also keeps them from transmitting HIV to sexual partners.
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Is The Risk Zero
In real-world terms, yes, the risk is zero. Its not helpful to focus on the theoretical risks because it is never possible to prove zero risk in science. Through statistical analysis, the estimated risk will keep getting closer and closer to zero. Researchers agree we can confidently say that a person with HIV on ART with an undetectable viral load cannot transmit HIV to their sexual partners. When someone is virally suppressed, they are not infectious and the risk of transmitting HIV is scientifically equivalent to zero.
Why Might People Living With Hiv Get Tested For Hiv
Because we connect with every single person who tests positive at one of our locations, we always ask why people get tested for HIV if theyve already been diagnosed in the past.
It happens for many reasons: People may test with a partner they havent yet disclosed to, they may have mental health concerns that come into play, or they need a letter of diagnosis to access services . Sometimes its because they are confused about the kind of information an HIV test will provide.
Now that weknow undetectable equals untransmittable , some people may have the misconception thatif youre undetectable, you will no longer test positive for HIV. They may think that if they test HIV-negative on an HIV test, theyll be able to show this to their sex partners as a way to prove that theyre undetectable and untransmittable. Or, they may think it will be easier to tell partners theyre HIV-negative rather than undetectable and uninfectious.
If you are living with HIV and have an undetectable viral load, you will still test positive for HIV. But, if you are living with HIV, have been taking HIV medications every day as directed, have a durably suppressed viral load and have been undetectable for at least six months, you will not transmit HIV to sex partners. You are not infectious. Thats the meaning of U=U.
Heres why you will still test positive for HIV even if you are undetectable.
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