The risk of sexual transmission of HIV in individuals with low-level HIV viraemia: a systematic review

Temporal dynamics and drivers of durable HIV viral load suppression and persistent high‐ and low‐level viraemia during Universal Test and Treat scale‐up in Uganda: a population‐based study

“…Lastly, multivariable Poisson regression-overall and stratified by sex and community type, respectively-with generalized estimating equations, exchangeable covariance matrices and robust standard errors modelled individual-level factors associated with persistent high-level viraemia, relative to sustained or new/renewed low-level viraemia or suppression (<1000 copies/ml across visits or at follow-up only). Given the elevated risks associated with onward HIV transmission among persons exhibiting high-level viraemia [22], sustained or new/renewed VLS or low-level viraemia served as the reference category in analysis. Assessed predictors (Table 1) included demographic (age, sex, marital status, education, occupation, household wealth [24], migration, community type) and behavioural factors (number of past-year sexual partnerships, condom use consistency across sexual partner types [25], transactional sex, hazardous alcohol use [measured from an aggregated count of eight alcohol use consequences [26]] and intimate partner violence perpetration or victimization [adapted from the Revised Conflicts Tactics Scale [27]]).…”

“…A VLS cutpoint of <200 HIV RNA copies/ml was selected to distinguish persons with potentially transmissible viraemia from those with no demonstrated risk of onward HIV transmission [22]. Four longitudinal virologic outcomes were identified within visit-pairs: (1) durable VLS (<200 copies/ml across visits); (2) new/renewed VLS (<200 copies/ml at follow-up only); (3) viral rebound (<200 copies/ml at index visit only); and (4) persistent viraemia (≥200 copies/ml across visits).…”

PEPFAR Reauthorization by Congress Urgent for Global Health

“…Virologic suppression will not just restore a normal lifespan for people with HIV, but also prevent forward transmission of the virus entirely (undetectable = untransmittable). 8 PEPFAR's next 5 years are completely aligned with UNAIDS goals for HIV, which will end AIDS as a public health threat by the end of this decade if fulfilled. PEPFAR currently proposes 5 strategic pillars to achieve these goals by ensuring health equity for priority populations, achieving long-term sustainability in the HIV/AIDS response, leveraging public health systems to respond to other health threats, strengthening partnerships, and guiding programs by data.…”

“…UNAIDS has set a target by 2030 of 95% of those living with HIV to know their infection status; 95% of those with HIV to be provided ART; and 95% of those receiving ART to achieve the goal of virologic suppression (the ultimate aim of therapy). Virologic suppression will not just restore a normal lifespan for people with HIV, but also prevent forward transmission of the virus entirely (undetectable = untransmittable) . PEPFAR’s next 5 years are completely aligned with UNAIDS goals for HIV, which will end AIDS as a public health threat by the end of this decade if fulfilled.…”

“…Long-acting injectable treatments are in an early stage—and have not yet been made accessible in low- and middle-income countries—but novel long-acting treatment combinations will require PEPFAR’s support and involvement when available. A recent systematic review showed that transmission from people with HIV with viral loads greater than 1000 copies/mL (with ART) is almost nonexistent, meaning our advances in treatment will also help break the cycle of transmission. The capacity of these new tools for HIV prevention and treatment to drive down incidence is largely predicated on PEPFAR reauthorization: without sustained investment through PEPFAR, their transformative potential is unlikely to be realized in the global health setting.…”