Near-Zero Risk of HIV Transmission With Low Viral Loads

BRISBANE, Australia – The risk of sexual transmission of HIV with viral loads of less than 1,000 copies per mL was almost zero, according to a meta-analysis and systematic review.

In eight studies involving 7,762 serodiscordant couples across 25 countries, there were two cases of possible transmission among patients who had detectable viral loads that were under that threshold, reported Lara Vojnov, PhD, of the World Health Organization in Geneva, in a presentation at the International AIDS Society Conference on HIV Science (IAS). The findings were simultaneously published in The Lancet.

In three studies, there was no HIV transmission when the partner living with HIV had a viral load less than 200 copies per mL, according to Vojnov and colleagues. And across four prospective studies, 323 transmissions occurred, but none of the transmissions occurred when infected partners were considered to have stably suppressed HIV, they said.

“Among all studies there were 2 cases of transmission when the index patient’s most recent viral load was less than 1000 copies per mL,” Vojnov’s group wrote. “However, interpretation of both cases was complicated by long intervals between the transmission date and the most recent index viral load result.”

“These data provide a powerful opportunity to destigmatize HIV and promote adherence to anti-retroviral therapy through dissemination of this positive public health message,” they stated. “These findings can also promote access to viral load testing in resource-limited settings for all people living with HIV by facilitating uptake of alternative sample types and technologies.”

However, the researchers emphasized that “these messages and results do not apply to transmission from mother to child. Because vertical transmission can occur during pregnancy, during childbirth, or through breastfeeding, the duration and intensity of exposure to viraemia is considerably higher than that of sexual transmission. There are also no data on risk of transmission through sharing of injection drug use equipment at varying levels of viraemia.”

The study coincided with a WHO policy brief, which addresses the issue of vertical mother-child transmission, stating that “[a]vailable evidence suggests that if a mother living with HIV is taking antiretroviral therapy and maintains a suppressed viral load during pregnancy, delivery and breastfeeding, the risk of vertical HIV transmission can be as low as
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