Negligible Risk of Sexual Transmission With Low HIV Viremia

TUESDAY, July 25, 2023 (HealthDay News) -- For patients with HIV with viral loads of <1,000 copies/mL, there is almost no sexual transmission among serodiscordant couples, according to a review published online July 23 in The Lancet to coincide with the IAS Conference on HIV Science, held from July 23 to 26 in Brisbane, Australia.

Laura N. Broyles, M.D., from the Global Health Impact Group in Atlanta, and colleagues conducted a systematic review and meta-analysis to summarize evidence relating to sexual transmission of HIV at varying HIV viral load levels in order to inform messaging for those living with HIV and their partners and health care providers. The analysis included eight studies, comprising 7,762 serodiscordant couples across 25 countries.

The certainty of evidence was moderate, and low risk of bias was seen. The researchers found that when the partner living with HIV had a viral load <200 copies/mL, there was no HIV transmission based on three studies. A total of 323 transmission events occurred across the remaining four prospective studies; none were in patients considered stably suppressed on antiretroviral therapy (ART). Two cases of transmission were identified among all studies when the index patients' most recent viral load was <1,000 copies/mL; interpretation of both cases was complicated by long intervals between most recent index viral load result and transmission date.

"The evidence showing almost zero risk of sexual transmission when HIV viral loads are less than 1,000 copies per mL provides a powerful opportunity to destigmatize people who are living with HIV and promote adherence to ART through dissemination of this positive public health message," the authors write.

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