Understanding the Risk of Human Immunodeficiency Virus (HIV) Virologic Failure in the Era of Undetectable Equals Untransmittable

Abstract

The “Undetectable = Untransmittable” campaign indicates that persons living with Human Immunodeficiency Virus (HIV) who maintain a suppressed viral load cannot sexually transmit the virus. However, there is little knowledge of the percent of individuals at a population level who sustain viral suppression long term. The aims of this study were to: (1) establish a baseline of persons living with diagnosed HIV who resided in New York and had consecutive suppressed viral load tests; (2) describe the risk of virologic failure among those who were consecutively suppressed; and (3) gain an understanding of the length of time between consecutive viral suppression to virologic failure. A total of 102,339 New Yorkers aged 13–90 years were living with diagnosed HIV at the beginning of 2012; 47.9% were consecutively suppressed (last two HIV viral load test results from 2010–2011 that were < 420 days apart and < 200 copies/mL). Of consecutively suppressed individuals, 54.3% maintained viral suppression for the entire study period and 33.6% experienced virologic failure during the study period. Among persons who experienced virologic failure, 82.6% did so six or more months after being consecutively suppressed. Our findings support the need for ongoing viral load monitoring, adherence support, and ongoing risk reduction messaging to prevent forward HIV transmission.

Efficacy, durability, and tolerability of bictegravir/emtricitabine/tenofovir alafenamide for the treatment of HIV in a real‐world setting in Belgium

“…Interestingly, however, SSA participants represented 71.4% of those who experienced loss of virological suppression despite this subgroup representing only 32.3% of the overall cohort. Indeed, it has been reported that SSA people living with HIV were at higher risk of loss of virological suppression than non‐SSA people with HIV [26]. Of the 14 participants experiencing loss of virological suppression, six did not have resistance data available at the time of loss of virological suppression.…”

Effectiveness and safety of community-led assisted partner service among HIV-diagnosed men who have sex with men: a multicentre, randomized controlled trial in China

“… 14 , 15 , 17 , 18 However, established HIV-diagnosed individuals diagnosed for more than 6 months may also not disclose their serostatus and encourage their sexual partners to test for HIV due to potential social discrimination. 19 , 20 Compared with newly HIV-diagnosed individuals, adherence to ART during a long time in established HIV-diagnosed individuals is not always satisfactory, 21 , 22 , 23 and unprotected sexual behaviours may exist more frequently for the concept of “undetectable equals untransmittable”. 24 When HIV-diagnosed individuals are not in care or in care but viraemic, the sexual partners of these HIV-diagnosed individuals are also at potential risk for HIV acquisition and need HIV testing service.…”

Predictors of Detectable Viremia, Outcomes, and Implications for Management of People Living With HIV Who Are Receiving Antiretroviral Therapy in Southern Nigeria

“…Data from high-income countries show a need for ongoing VL monitoring even after achieving viral suppression. Laprise et al studied the long-term effect of persistent low-level viremia among a cohort of PWH, while Gunn et al showed that a third of participants experienced virologic failure despite attaining sustained viral suppression [ 17 , 18 ]. However, there are limited data on the outcome of clients who attain undetectable VL levels in low- and middle-income countries.…”