Achieving undetectable HIV viral load reduces transmission risk – Physicians

Chijioke Iremeka

The World Health Organisation, public health practitioners and quite a number of studies have shown that having an undetectable viral load reduces the risk of Human Immunodeficiency Virus transmission through needles, syringes and other shared sharp objects.

They stressed that taking medicine as prescribed or medication adherence when it comes to HIV antiretroviral therapy, which would help as well as keeping an undetectable viral load, would make HIV transmission to loved ones, children and sex partners less possible.

According to WHO, keeping an undetectable viral load is the best way to stay healthy and protect others from getting infected.

Antiretroviral therapy, the UN health body explained is a group of medications that treat HIV.

It noted drugs do not kill or cure the virus, however, when taken in combination they can slow down or prevent the growth of the virus.

More so, the latest scientific and normative guidance on HIV released by WHO, during its 12th International AIDS Society Conference on HIV Science, explained the role of HIV viral suppression and undetectable levels of the virus in improving individual health and halting onward HIV transmission.

The guidance and an accompanying Lancet systematic review said people living with HIV who achieve an undetectable level of the 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.

According to WHO, “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.

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

He noted that at the end of 2022, 29.8 million out of the 39 million people living with HIV were taking antiretroviral treatment, which meant 76% of all people living with HIV with almost three-quarters of them (71%) living with suppressed viral load.

“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 very positive progress for adults living with HIV, viral load suppression in children living with HIV is only 46% – a reality that needs urgent attention,” WHO stated.

Speaking on how ART works, a Professor of Public Health and Consultant Public Health Physician at the University of Ilorin Teaching Hospital, Tanimola Akande, said ART is meant to reduce the viral load since HIV cannot be cured.

He said, “While I can’t say that HIV patients with reduced viral load are no longer at risk of transmitting the virus to others, we advised them to make use of protection whenever they want to have sex with their partners.

“We advise them to use condoms and ensure that they are not engaged in unprotected sex with their partners. Taking their medications will reduce the viral load and they can live normal lives. That is much the ART can do for now.”

In the same vein, a Chief Nursing Officer at the Infectious Disease Centre, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Mrs. Joy Mbonu, said there has been an improvement in the areas of HIV prevention and control in the country.

She said with the increasing number of undetected HIV viral loads as a result of ART treatment and usage, the rate of HIV transmission will reduce drastically and urged those with the virus to take proper precautions against HIV transmission.

Mbonu called on those living with HIV and AIDs to ensure religious adherence to their medication, advising them not to relent in taking their medications on the basis that they are already HIV positive and therefore, will not contract it again.

She also urged them to always check their HIV status and ensure there is no re-infection that would worsen their situation, adding that with reduced viral load, an HIV positive person will not be able to transmit the disease to another person, partner, or even a pregnant or nursing mother to her baby.

According to findings by the Research Department of Statista, published in August 2022, 1.9 million people in Nigeria were infected with HIV as of 2021, and about 90 per cent of them were receiving ART.

It also noted that between 2010 and 2021, the share of people on ART grew consistently.

However, WHO, the Global Fund and UNAIDS all have global HIV strategies that are aligned with SDG target 3.3 of ending the HIV epidemic by 2030.

“By 2025, 95% of all people living with HIV should have a diagnosis, 95% of those should be taking lifesaving antiretroviral treatment (ART) and 95% of PLHIV on treatment should achieve a suppressed viral load for the benefit of the person’s health and for reducing onward HIV transmission,” WHO added.

A public health practitioner at Holy Family Hospital, Festac, Lagos, Esther Christian, said there are a number of ways to test for HIV, saying that the main goal of treatment is to reach and maintain an undetectable viral load.

She noted that ART involves taking several drugs that prevent HIV from replicating and reduce the viral load to give the immune system a chance to produce more CD4 cells and fight off infections.

She said, “ART drugs itself can’t completely remove HIV from the body but by reducing the viral load to an undetectable level, it effectively prevents transmission of the virus to others during sex.

“People must continue to take daily antiretroviral drugs to maintain an undetectable viral load. Patients undergoing ART will receive a viral load test once they start treatment.

“A doctor will generally recommend going in for a viral load test in four to six-week increments, or more often if a person is at a later stage of the condition.”

 

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