KUALA LUMPUR, July 24 – The World Health Organization (WHO) has released new guidance on HIV viral suppression, where antiretroviral therapy (ART) acts as both treatment and prevention of HIV infection.
The WHO’s guidance – released at the International AIDS Society’s (IAS) 12th International IAS Conference on HIV Science in Brisbane, Australia, yesterday – stated that people living with HIV, who achieve an undetectable level of virus by consistent use of ART, do not transmit HIV to their sexual partners.
These people with undetectable HIV viral loads are also at low risk of transmitting the virus to their children.
The evidence also indicates that there is “negligible, or almost zero, risk of transmitting HIV” when a person has a HIV viral load measurement of less than or equal to 1,000 copies per mL, also commonly referred to as having a suppressed viral load, WHO said.
“For more than 20 years, countries all over the world have relied on WHO’s evidence-based guidelines to prevent, test for and treat HIV infection,” said WHO director-general Tedros Adhanom Ghebreyesus in a press statement yesterday.
“The new guidelines we are publishing today will help countries to use powerful tools [that] have the potential to transform the lives of millions of people living with or at risk of HIV.”
The WHO also released an accompanying Lancet systematic review of 244 studies involving 24 countries. Three studies showed no HIV transmission when the partner living with HIV had a viral load less than 200 copies per mL. Across the remaining four prospective studies, there were 323 transmission events; none were in patients considered stably suppressed on ART.
“There is almost zero risk of sexual transmission of HIV with viral loads of less than 1000 copies per mL. These data provide a powerful opportunity to destigmatise HIV and promote adherence to ART through dissemination of this positive public health message,” concluded the systematic review by the medical journal.
According to statistics released by the WHO, at the end of 2022, about 29.8 million people (76 per cent) of 39 people living with HIV were taking ART, with almost three-quarters of them (71 per cent) living with suppressed HIV.
“This means that for those virally suppressed their health is well protected and they are not at risk of transmitting HIV to other people,” said the WHO’s statement.
“Antiretroviral therapy continues to transform the lives of people living with HIV. People living with HIV who are diagnosed and treated early, and take their medication as prescribed, can expect to have the same health and life expectancy as their HIV-negative counterparts.”
The WHO, however, also noted that viral load suppression in children living with HIV was only 46 per cent – “a reality that needs urgent attention”.
Bruce Richman – the founding executive director of Prevention Access Campaign, a US-based nonprofit that promotes the U=U (undetectable = untransmittable) campaign – described the WHO’s new HIV guidance as a “game-changer”.
“Previously, official confirmation of an undetectable viral load was considered dependent on plasma-based tests not available in many settings,” he said in a statement.
“The WHO clarification that an undetectable viral load can be confirmed by any WHO-approved test, is a game-changer for health equity, particularly in lower-income countries where plasma-based tests are not cost-effective and scalable.
“When the WHO’s new brief is translated from policy to implementation, millions more people living with HIV will have the assurance that they’re staying healthy and can’t pass on HIV.”
