U=U: An important message for people living with HIV

Have you heard about U=U?

Undetectable=untransmittable (U=U) is an exciting breakthrough in our understanding of HIV transmission risk in patients who are virally suppressed (defined as less than 200 copies of HIV in the blood). Major health authorities around the world, including the Centers for Disease Control (CDC), have endorsed U=U. For people living with HIV (PLWH), their communities, and society as a whole, the health implications and potential impact are huge.

U=U means that PLWH who are on antiretroviral therapy (ART) with an undetectable viral load in their blood have effectively no risk of transmitting HIV to their sexual partners.

It’s also important, though, to know what it doesn’t mean. U=U doesn’t protect against other means of HIV transmission (such as breastfeeding or needle sharing), and it only protects against the spread of HIV and not against other STDs or pregnancy. And, depending on the medications being taken for ART and other factors, it may take as long as six months for a PLWH to become undetectable once they start treatment.

Multiple studies going as far back as 1998 support the science behind U=U. In two major studies that looked at over 70,000 condomless sex acts between HIV-mixed (also known as serodiscordant) couples, zero HIV transmissions to HIV negative partners occurred when the partners with HIV were virally suppressed. In another, over 1,500 serodiscordant couples — both hetero- and homosexual — from nine different countries were studied over a five-year period. Throughout the study, there were zero cases of HIV transmission between a partner living with HIV who was virally suppressed to an uninfected partner. This study also found that PLWH who were started on ART earlier in their diagnosis had fewer health complications related to their HIV than those who were not receiving ART or delayed starting ART.

To summarize the research, not one virally suppressed HIV-positive patient transmitted HIV to their partner in any of the studies conducted.

If you’re living with HIV, taking your medications as prescribed, and have an undetectable viral load, we can now say with confidence that you cannot pass HIV along to your sexual partners.

This opens up tons of possibilities when it comes to reproductive options and sexual health decisions. With the addition of U=U to the other HIV transmission prevention strategies including pre-exposure prophylaxis (PrEP) and condoms, we now have an HIV prevention toolkit that allows PLWH and their partners to make informed decisions and customize their approach to maintaining their health and their partner’s health, and preventing HIV and STI transmission.

1. Make it personal. U=U is an added benefit for PLWH who are well controlled on ART, but the most important reason to be on ART is for their personal, lifelong health. The decision to start ART and what regimen is best should be made on an individual basis.
2. Adherence is everything. Continued and reliable HIV suppression requires being on the right ART medications and adhering to treatment, with HIV viral levels monitored regularly to assure undetectable status. Labs to monitor HIV are generally recommended every 3-6 months. If you are living with HIV, virally suppressed, and taking your medications as prescribed, you can feel confident you won’t transmit HIV.
3. Stay in care. Regular care with your provider helps identify any issues with an ART regimen before it might become a problem. By getting labs done regularly and taking your medication as prescribed, you can maintain an undetectable viral load which will keep you healthy and protect your partners from HIV.
4. U=U is only true for sexual transmission. So far, the research for U=U is only based on sexual transmission of HIV, not on other means of transmission (such as breastfeeding or sharing needles).
5. U=U does not protect against other STIs or pregnancy. Condoms help protect against STIs, pregnancy, and HIV. Your healthcare provider can discuss other birth control and family planning options that are right for you.
6. U=U is information, not judgement. PLWH are not defined by if they are on ART, their viral load, or their sexual practices. An undetectable viral load is one option to prevent HIV transmission.
7. U=U might be the right HIV prevention strategy for you and your partner. PrEP is not medically necessary when the PLWH is undetectable and sticks with their treatment regimen. However, the HIV-negative partner may want to consider PrEP if they’re having sex with other partners or desire a feeling of personal agency regarding their own HIV protection.

At One Medical, we have providers at most of our locations who can provide HIV care in the primary care setting. A number of our providers have completed advanced training in HIV care, including certification from the American Academy of HIV Medicine. Our providers can work with you to get to U=U.