Updated as of September 12, 2016
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Sept
6, 2016: Research shows that people with HIV who are on effective
treatment cannot pass on the virus to their partners. People with HIV
and our allies are working together to ensure that messages is shared --
loud and clear!
Thank you to Linus Ignatius all your work and creativity in producing this video.
#UequalsU #FactsNotFear #ScienceNotStigma
For more information and to sign-up for updates see: preventionaccess.org/undetectable-untransmittable.
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RISK OF SEXUAL TRANSMISSION OF HIV FROM A PERSON LIVING WITH HIV WHO HAS AN UNDETECTABLE VIRAL LOAD
Messaging Primer & Consensus Statement
There
is now evidence-based confirmation that the risk of HIV transmission
from a person living with HIV (PLHIV), who is on Antiretroviral Therapy
(ART) and has achieved an undetectable viral load in their blood for at
least 6 months is negligible to non-existent.
While HIV is not always transmitted even with a detectable viral load,
when the partner with HIV has an undetectable viral load this both
protects their own health and prevents new HIV infections.[i]
However,
the majority of PLHIV, medical providers and those potentially at risk
of acquiring HIV are not aware of the extent to which successful
treatment prevents HIV transmission.[ii] Much of the messaging about HIV
transmission risk is based on outdated research and is influenced by
agency or funding restraints and politics which perpetuate
sex-negativity, HIV-related stigma and discrimination.
The
consensus statement below, addressing HIV transmission risk from PLHIV
who have an undetectable viral load, is endorsed by principal
investigators from each of the leading studies that examined this issue.
It is important that PLHIV, their intimate partners and their
healthcare providers have accurate information about risks of sexual
transmission of HIV from those successfully on ART.
At
the same time, it is important to recognize that many PLHIV may not be
in a position to reach an undetectable status because of factors
limiting treatment access (e.g., inadequate health systems, poverty,
racism, denial, stigma, discrimination, and criminalization),
pre-existing ART treatment resulting in resistance or ART toxicities.
Some may choose not to be treated or may not be ready to start
treatment.
Understanding
that successful ART prevents transmission can help reduce HIV-related
stigma and encourage PLHIV to initiate and adhere to a successful
treatment regimen.
The following statement has been endorsed by:
-
Dr. Myron Cohen – Principal Investigator, HPTN 052; Chief, Division of Infectious Diseases, UNC School of Medicine, North Carolina, USA
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Dr. Demetre C. Daskalakis, MPH - Assistant Commissioner, Bureau of HIV/AIDS Prevention and Control New York City Department of Health and Mental Hygiene, New York, USA
-
Dr. Andrew Grulich – Principal Investigator, Opposites Attract; Head of HIV Epidemiology and Prevention Program, Kirby Institute, University of New South Wales, Australia
-
Dr. Jens Lundgren – Co-principal Investigator, PARTNER; Professor, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Denmark
-
Dr. Julio Montaner - Director of the British Columbia Centre for Excellence in HIV/AIDS; Director of IDC and Physician Program Director for HIV/AIDS PHC, Vancouver BC, Canada
-
Dr. Pietro Vernazza – Executive Committee, PARTNER; Author, Swiss Statement 2008, Update 2016; Chief of the Infectious Disease Division, Cantonal Hospital in St. Gallen, Switzerland
Organizational endorsements:
People
living with HIV on ART with an undetectable viral load in their blood
have a negligible risk of sexual transmission of HIV. Depending on the
drugs employed it may take as long as six months for the viral load to
become undetectable. Continued and reliable HIV suppression requires
selection of appropriate agents and excellent adherence to
treatment. HIV viral suppression should be monitored to assure both
personal health and public health benefits.
NOTE:
An undetectable HIV viral load only prevents HIV transmission to sexual
partners. Condoms also help prevent HIV transmission, as well as other
STIs and pregnancy. The choice of HIV prevention method may be different
depending upon a person’s sexual practices, circumstances and
relationships. For instance, if someone is having sex with multiple
partners or in a non-monogamous relationship, they might consider using
condoms to prevent other STIs.
“NEGLIGIBLE” = so small or unimportant as to be not worth considering; insignificant.
ADDITIONAL EXPERT QUOTES, SOURCES, AND EXPLANATIONS [iii]
1.
“..Once you begin therapy, you stay on therapy, with full virologic
suppression you not only have protection from your own HIV….. but you
also are not capable of transmitting HIV to a sexual partner. With
successful antiretroviral treatment, that individual is no longer
infectious.” Dr. Carl Dieffenbach, Director of the Division of AIDS,
National Institutes of Health. NIH Video interview (August, 2016)
2.
"The force of evidence in both real world and clinical trial experience
confirms that individuals with suppressed viral loads have a negligible
risk of transmitting HIV. Treatment as prevention, pre-exposure
prophylaxis, and traditional prevention measures, like condoms, make up
an HIV prevention toolkit based in harm-reduction that allows
individuals to make personalized and enlightened decisions to both
maintain their health and prevent HIV and STI transmission.” Dr. Demetre C Daskalakis, MPH
- Assistant Commissioner, Bureau of HIV/AIDS Prevention and Control New
York City Department of Health and Mental Hygiene (July 2016)
3.
“Does this work over a long period of time for people who are anxious
to be suppressed? The answer is absolutely yes, we now have 10,000
person years (of follow-up) with zero transmissions from people who are
suppressed." Dr. Myron Cohen. Medpage; NEJM. (July 2016)
4.
“We can now say with confidence that if you are taking HIV medication
as prescribed, and have had an undetectable viral load for over six
months, you cannot pass on HIV with or without a condom." Dr. Michael Brady, Medical Director, Terrence Higgins Trust, London, England(July 2016)
5.
“Among serodifferent heterosexual and MSM couples in which the
HIV-positive partner was using suppressive ART and who reported
condomless sex…there were no documented cases of within-couple HIV
transmission” among 58,000 condomless sex acts. Reporting on PARTNER
study Dr. Alison Rodger, et al. JAMA. (July 2016)
6.
“These results are simple to understand – zero transmissions from over
58,000 individual times that people had sex without condoms…[PARTNER
study] provides the strongest estimate of actual risk of HIV
transmission when an HIV positive person has undetectable viral load –
and that this risk is effectively zero.“ Simon Collins, Steering Committee, PARTNER, i-BASE (July 2016)
7.
"The [Swiss] statement [was the first position statement that]
addressed the infectiousness of an HIV-positive person once the virus
was stably suppressed for at least 6 months with ART. [T]he [Swiss
Federal Commission for AIDS-related Issues] felt, based on an expert
evaluation of HIV transmission risk under therapy, that the risk of HIV
transmission in such a situation was negligible.” Dr. Pietro Vernazza, chief of the Infectious Disease Division, Cantonal Hospital in St. Gallen, Switzerland; Executive Committee, PARTNER Swiss Medical Weekly (Jan. 2016, confirming the original 2008 Swiss statement)'
8.
“[T]he HPTN 052 study saw only cases of transmission during ART that
occurred shortly (days) after the initiation of therapy. If only
transmissions after the first six months of ART are considered (as
stipulated in the Swiss statement) the efficacy would have been 100%
with a transmission risk of zero.” Dr. Pietro Vernazza, Swiss Medical Weekly (Jan. 2016)
9. “We have…rigorous confirmation that treatment prevents the spread of HIV and improves the health of infected people.” Dr. Thomas R. Frieden, Center for Disease Control Director, USA New England Journal of Medicine sourcing HPTN 052 & PARTNER studies (Dec. 2015)
10. “[People with HIV] will not pass on the infection, if the virus is undetectable, to their partners...” Professor David Cooper - Director of the Kirby Institute for Infection and Immunity in Society. University of NSW, Australia; ABC AU interview (May 2015)
11.
“When you treat a person who is HIV infected you render them no longer
contagious. Over a period of years that benefit is further realized…
Sexual relationships can be much safer because [treatment] suppresses
transmission. There is a societal benefit, a public health benefit, an
altruistic benefit. ” Dr. Myron Cohen, Chief, Division of Infectious Diseases, UNC School of Medicine, North Carolina, USA; Principal Investigator, HPTN 052 At IAS Meeting, (2015)
12.
When asked what the study tells us about the chance of someone with an
undetectable viral load transmitting HIV, presenter Alison Rodger said:
"Our best estimate is it's zero." Reporting on PARTNER study interim
results. Dr. Alison Rodger, University College London, United Kingdom; Lead Author PARTNER, NAM -AIDSMap (March, 2014)
13.
People living with HIV “are leading lives that are normal in quality
and length. With effective treatment, they are not infectious.” Health
care workers on effective HIV treatment are “totally safe.” Professor Dame Sally Davies, Chief Medical Officer, England. The Telegraph (Aug. 2013)
14.“In reality, if you give the treatment the opportunity to get on with its work, you will have zero transmission”. Dr. Julio Montaner,
Director of the British Columbia Centre for Excellence in HIV/AIDS;
Director of IDC and Physician Program Director for HIV/AIDS PHC: TED Talk referring to HPTN 052 (Nov. 2011).
[i]
Much of the current prevention messaging refers to this as Treatment as
Prevention or TasP. As of the writing of this primer, there have been
no confirmed cases of HIV transmission from a person with an
undetectable viral load in any studies. The official cut-off point for
an undetectable viral load as defined by the WHO ranges from <50
copies/ml in high income countries to <1,000 copies/ml in low to
middle-income countries. For the purposes of this statement, an
undetectable viral load is defined as under <200 copies/ml.
[ii]
Only a small proportion of HIV-positive people in a large US treatment
study regarded themselves as non-infectious after up to three years on
antiretroviral therapy (ART), and a third of participants regarded their
chance of infecting a partner as still ‘high’, even though only 10% of
participants actually had a detectable viral load.” NAM- AIDSMap (2016)
[iii] Acknowledgements: In addition to PAC’s Founding Task Force, Professor Carrie Foote (Indiana University-Indianapolis) and Edwin Bernard (HIV Justice Network), reviewed and provided valuable input on the Primer.
#UequalsU #FactsNotFear #ScienceNotStigma
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