Viral suppression reduces HIV transmission to partners, children – Experts

Chijioke Iremeka

Experts say people living with the Human Immunodeficiency Virus, who achieve an undetectable level of the virus by consistent use of antiretroviral therapy, cannot transmit HIV to their sexual partner and are at low risk of transmitting the virus to their children.

They noted that evidence from the World Health Organisation indicates that there is negligible, or almost zero risk of transmitting HIV when a person has a viral load measurement of less than or equal to 1000 copies per mL.

According to a Paediatrician with Holy Family Hospital, Festac, Lagos, Dr. Esther Christian, those living with HIV/AIDS that have achieved reduced viral load by regularly taking antiretroviral drugs will not transmit HIV to their spouses, friends or family members.

She said, “The whole essence of antiretrovirals is to reduce the viral load of the person’s HIV to the point that it cannot infect any other person. People living with reduced viral load can live their lives normally without creating problems for other people.

“This is what the world intends to achieve with awareness of HIV. For instance in some hospitals, before a patient is attended to, we need to ascertain the patient’s HIV status. Once the test turns out positive, we will introduce antiretrovirals after counselling, to let the patient know that those living with HIV/AIDS can live their normal lives and achieve their life ambitions if they stick to their medications.

“We have a number of them that we have referred to government hospitals and NGOs, where they can get these drugs for free and continue to lead normal lives. HIV shouldn’t be a death sentence for anybody. We have seen people with HIV who didn’t die of the virus, but rather of other natural causes. So, we are harping on the religious adherence to antiretrovirals as a way of reducing the transmission rate of HIV/AIDS in Nigeria as well as the world because it is a trans-border sickness.”

According to the WHO, antiretroviral therapy continues to transform the lives of people living with HIV/AIDs, noting that those living with the virus and 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.

In the new guideline and scientific updates released at the ongoing 12th International AIDS Society Conference on HIV Science, (IAS 2023) in Australia, and its accompanying Lancet systematic review, WHO described the role of HIV viral suppression and undetectable levels of virus in both improving individual health and halting onward HIV transmission.

The guidance described key HIV viral load thresholds and approaches to measure levels of virus against these thresholds, saying people living with HIV, who achieve an undetectable level of virus by consistent use of antiretroviral therapy, do not transmit HIV to their sexual partners and are at low risk of transmitting HIV vertically to their children.

“The evidence also indicates that there is negligible, or almost zero, risk of transmitting HIV when a person has an HIV viral load measurement of less than or equal to 1000 copies per mL, also commonly referred to as having a suppressed viral load.

“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 Dr. Tedros Adhanom Ghebreyesus, WHO Director-General.

“The new guidelines we published today will help countries to use powerful tools to have the potential to transform the lives of millions of people living with or at risk of HIV.”

He noted that at the end of 2022, 29.8 million of the 39 million people living with HIV, were taking antiretroviral treatment, which means that 76 per cent of all people living with HIV, with almost three-quarters of them (71 per cent) are 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. While this is a positive progress for adults living with HIV, viral load suppression in children living with HIV is only 46 per cent, a reality that needs urgent attention,” Ghebreyesus noted.

According to an analysis of global surveillance data reported to WHO during the multi-country outbreak of mpox, in over 82 000 mpox cases, around 32 000 cases had information on their HIV status.

Among this number, 52 per cent were living with HIV, most being men who have sex with men (MSM), and more than 80 per cent reported sex as the most probable route of getting infected with pox.

“Among 16 000 people diagnosed with mpox and living with HIV, around one quarter (25%) had advanced HIV disease or immunosuppression, leading to an increased risk of hospitalisation and death.

“People living with HIV, who were taking HIV treatment and with good immunity had similar hospitalisation and death outcomes as those who were HIV negative.

“In the light of these findings, WHO recommends countries to integrate mpox detection, prevention, and care with existing and innovative HIV and sexually transmitted infection prevention and control programmes,” the data indicated.


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