For HIV, undetectable is equal to untransmittable

The National Institutes of Health (NIH) has said that the Undetectable = Untransmittable (U=U) concept for HIV is a scientifically sound concept. Officials from NIH’s National Institute of Allergy and Infectious Diseases (NIAID) have reviewed results from large clinical trials and cohort studies for U=U, which validate the concept, in an article published in JAMA, Jan. 10, 2019.

U=U means that people living with HIV who have achieved and maintained an undetectable viral load (less than 40 copies in one ml of blood)) by taking and adhering to antiretroviral therapy (ART) as prescribed cannot sexually transmit the virus to others.  The U=U initiative was launched in 2016 by the Prevention Access Campaign with the goal of ending the HIV/AIDS pandemic as well as HIV-related stigma. As a prevention strategy, this is often referred to as Treatment as Prevention

The landmark NIH-funded HIV Prevention Trials Network (HPTN) 052 clinical trial showed that no linked HIV transmissions occurred among HIV serodifferent heterosexual couples when the partner living with HIV had a durably suppressed viral load. These findings were further confirmed by the PARTNER (1 and 2) and Opposites Attract studies, which extended these findings to male-male couples.

Validation of the HIV treatment as prevention strategy and acceptance of the U=U concept as scientifically sound have numerous behavioral, social and legal implications, says NHI.

U=U can help control the HIV pandemic by preventing HIV transmission, and it can reduce the stigma that many people with HIV face. The success of U=U as an HIV prevention method depends on achieving and maintaining an undetectable viral load by taking ART daily as prescribed. 

Implementing programs that help patients remain in care and addressing the barriers to daily therapy can enhance the overall success of U=U.

In September 2017, the Division of HIV/AIDS Prevention, US Centers for Disease Control and Prevention (CDC) has also said that “people who take ART daily as prescribed and achieve and maintain an undetectable viral load have effectively no risk of sexually transmitting the virus to an HIV-negative partner”.

(Source: NIH)

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA