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Undetectable = Untransmittable

By Working Nurse
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It’s one of the most important HIV stories in 30 years: The results of the PARTNER2 trial, announced in July, provide even stronger evidence that HIV-positive patients with undetectable viral loads cannot sexually transmit HIV.

The Effectiveness of ART

For the past decade, a growing body of research has suggested that suppressive antiretroviral therapy (ART) greatly reduces an HIV-positive patient’s risk of sexually transmitting the virus to others.  The first PARTNER study, completed in 2014, tracked 880 serodifferent couples — some male-female, some male-male — where the HIV-positive partner’s viral RNA load was completely suppressed by ART.  Over several years of unprotected sex, there were zero cases of partner-to-partner HIV transmission.  PARTNER2 followed an additional 635 male-male couples over a four-year period. At the 22nd International AIDS Conference last month, researchers announced the results: zero cases of partner-to-partner transmission over multiple years of unprotected sex.  Allison J. Rodger, M.D., lead researcher on both studies, says, “We looked so hard for transmissions. And we didn’t find any.”

“Robust Evidence”

Although previous research suggested that the risk of virally suppressed patients sexually transmitting HIV was close to zero, there was enough statistical uncertainty for researchers to hedge their bets, particularly for men who have sex with men.  Following the conclusion of PARTNER2, Rodger uses stronger words: “The risk is zero,” she declares, calling the evidence “robust.” These results are exciting news for HIV prevention, but they emphasize the importance of testing and treatment. If patients discontinue or fail to adhere to their ART regimen (for instance, due to a loss of health insurance), their viral loads will increase and there is once again a risk of sexual transmission.

Above: Alison Rodger at the PARTNER 2 press conference. Photo by Liz Highleyman.

This article is from workingnurse.com.

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