Evaluating HIV Viral Rebound Among Persons on Suppressive Antiretroviral Treatment in the Era of “Undetectable Equals Untransmittable (U = U)”

Abstract

Background Studies have demonstrated that persons with HIV (PWH) maintaining viral suppression do not transmit HIV to HIV-negative partners through condom-less sex, leading to the “Undetectable = Untransmittable” (U=U) prevention campaign. However, few studies have examined the durability of suppression in the era of U=U. Methods This retrospective cohort study was conducted in Providence, RI. PWH age ≥18 years with documented viral suppression [defined as at least 1 viral load (VL) <200 copies/mL and no VL ≥200 copies/mL] in 2015 were included in the baseline cohort. Primary outcomes were viral suppression, viral rebound (at least 1 VL ≥200 copies/mL), or gap in VL monitoring assessed annually from 2016-2019. Those with viral rebound were assessed for re-suppression within six months. Demographic and clinical characteristics associated with viral rebound or gaps in VL monitoring were investigated by bivariate analysis and logistic regression. Results 1242 patients with viral suppression were included in the baseline cohort. In each follow-up year, 85-90% maintained viral suppression, 2-5% experienced viral rebound, and 8-10% had a gap in VL monitoring. Among those with viral rebound, approximately one-half were suppressed again within 6 months. In the logistic regression models, retention-in-care was significantly associated with viral suppression, while younger age, black race, high school or equivalent education, non-MSM, and history of incarceration were significantly associated with viral rebound. Conclusions In the U=U era, most patients with viral suppression who are retained in care are likely to maintain viral suppression over time. Some patients require additional support for regular VL monitoring.

Durability of HIV viral suppression and associated factors among adults living with HIV initiated on antiretroviral therapy in Tanzania: a retrospective cohort study

“…The overall proportion of durable viral suppression in this study was similar to studies in Belgium and USA (10,11) respectively. On the other hand, it was a bit higher than a study (12,13) and different from reports from (14-16).…”

Poor adherence to antiretroviral therapy among adult people living with HIV initiated during the COVID-19 epidemic waves – observations at the University Teaching Hospital in Lusaka, Zambia

“…Instead, we believe the campaign should be further strengthened and revived because it has a place in the HIV response program, especially as the world is strategizing for functional endgame approaches in the fight against HIV. This is because the U=U campaign initiative, which was first launched by the Prevention Access Campaign in 2016, bears the message that PLWHIV on ART for at least 6 months and who take ART medications daily as prescribed achieve and maintain an undetectable viral load (< 200 copies/ml), and thus have effectively no risk of sexually transmitting the virus through unprotected vaginal or anal sex to their HIV-uninfected sexual partners ( 5 ). Further evidence suggests that when healthcare providers discuss this U=U message with PLWHIV, there is further improved ART adherence and viral suppression ( 8 ).…”

“…Therefore, in 2016, the Prevention Access Campaign, a health equity initiative to end the HIV/AIDS pandemic as well as HIV-related stigma through the use of treatment as prevention (TasP), launched the ‘Undetectable equals Untransmittable' (U=U) initiative ( 4 ). The scientific evidence for U=U came from studies conducted at the time (HPTN 052, PARTNER, Opposites Attract, and PARTNER 2) that demonstrated that PLWHIV on ART for at least 6 months and who take medication daily as prescribed and achieve and maintain an undetectable viral load, defined as a viral load of fewer than 200 copies of HIV RNA per milliliter of plasma, have effectively no risk of sexually transmitting the virus through unprotected vaginal or anal sex to their HIV-uninfected sexual partners ( 5 ).…”

HIV-Related Stigma Reduction in the Era of Undetectable Equals Untransmittable: The South Korean Perspective

“…This indicates that the detection of HIV genetic material in genital fluids was not associated with HIV transmission. According to a retrospective cohort study only 2.4 - 5.1% of research participants experienced viral rebound (defined as >200 copies/ml) in four years of follow-up [ 22 ]. It also confirmed that retention in care was associated with viral suppression; younger individuals or those who are incarcerated need more support for regular visiting.…”