Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study
The Lancet, Published Online May 2, 2019
The level of evidence for HIV transmission risk through condomless sex in serodifferent gay couples with the HIV-positive partner taking virally suppressive antiretroviral therapy (ART) is limited compared with the evidence available for transmission risk in heterosexual couples. The aim of the second phase of the PARTNER study (PARTNER2) was to provide precise estimates of transmission risk in gay serodifferent partnerships.
Between Sept 15, 2010, and July 31, 2017, 972 gay couples were enrolled, of which 782 provided 1593 eligible couple-years of follow-up with a median follow-up of 2·0 years (IQR 1·1–3·5). At baseline, median age for HIV-positive partners was 40 years (IQR 33–46) and couples reported condomless sex for a median of 1·0 years (IQR 0·4–2·9). During eligible couple-years of follow-up, couples reported condomless anal sex a total of 76 088 times. 288 (37%) of 777 HIV-negative men reported condomless sex with other partners. 15 new HIV infections occurred during eligible couple-years of follow-up, but none were phylogenetically linked within-couple transmissions, resulting in an HIV transmission rate of zero (upper 95% CI 0·23 per 100 couple-years of follow-up).
Our results provide a similar level of evidence on viral suppression and HIV transmission risk for gay men to that previously generated for heterosexual couples and suggest that the risk of HIV transmission in gay couples through condomless sex when HIV viral load is suppressed is effectively zero. Our findings support the message of the U=U (undetectable equals untransmittable) campaign, and the benefits of early testing and treatment for HIV.
Healthcare providers should inform all patients with HIV they cannot transmit HIV to a sexual partner when their viral load is undetectable, argue the authors of a strongly worded comment in The Lancet HIV.
The authors note that despite overwhelming scientific data supporting the undetectable = untransmittable (U=U) message, significant numbers of healthcare providers do not educate their patients about U=U when telling them their viral load is undetectable.
In 2016, more than 80% of new HIV infections in the United States were transmitted by individuals who either did not know they were infected with HIV or had been diagnosed but were not receiving care, according to data released on the first day of the National HIV Prevention Conference in Atlanta.
by Nicholas Medland, Sexual health physician and senior researcher, UNSW
Australia aims to “virtually eliminate” HIV transmission by 2022, according to the health minister’s new national HIV strategy. This ambitious goal has been made possible by biomedical HIV prevention, a new and highly effective way of preventing HIV using medications.
But new inequalities are emerging between those who can and can’t access these medications because of their Medicare eligibility. These inequalities may undermine the success of HIV elimination in Australia and threaten Australia’s international reputation as a safe place to study, work and live.
Australian Government Department of Health, 29 November 2018
The Australian Government is strengthening its commitment to ending HIV with the announcement of funding for a new strategy that aims to virtually eliminate the transmission of HIV, the approval of the first HIV self-testing kit and the listing of a new medicine on the PBS.
The first HIV self-testing kit, the Atomo Self Test was approved for use by the TGA yesterday. The test is a single-use rapid finger stick test for the detection of antibodies to HIV and will enable people to test for HIV in their own home.
This will make testing accessible and convenient especially for people that need to test frequently or do not test at all.
The medicine Juluca® (dolutegravir and rilpivirine), which works to stop the replication of the HIV virus, will be listed on the PBS on December 1, which is World AIDS Day.
Since its announcement, Undetectable equals Untransmittable (U=U) has become a call to action to assert that when someone living with HIV has an undetectable viral load they cannot transmit HIV. Additionally, the U=U message
is evolving to challenge notions of HIV infectivity, vulnerability and stigma.
The science behind the U=U message provides the evidence that we can reduce the anxiety related to the sexual transmission of the HIV virus with confidence.
To contribute to getting this message out, ICASO produced a Community Brief on U=U. This community brief explains why it is so important to understand what ‘U=U’ means for women. The brief documents the experiences and needs of individual women living with HIV from all over the world. Important questions still remain that need to be answered to make the U=U message relevant, understandable and more meaningful to women in their diversity.