How effective treatment can halt HIV transmission

As Nigeria joins other countries to mark the 2017 World AIDS Day, experts, in this report by Sade Oguntola, say that there is a glimmer of hope on preventing HIV, considering current findings that people living with HIV who are on treatment and have an undetectable viral load may not transmit HIV to their HIV negative sexual partners.

Back in the 1990s, a diagnosis of HIV was a death sentence. In fact, many people assumed that hope was lost on achieving many goals in life, bring up a family and even living till old age.

Today, however scientists have achieved stunning victories in the effort to combat the virus. Not only are they successful in treating HIV, they are also succeeding in preventing it.

Improved access to effective antiretroviral therapy (ARVs) has brought back confidence and restored hope. “I used to tell people that it is a matter of choice if you want to die of HIV/AIDS at this time because we have gone past the period when the illness was killing people because of lack of knowledge, shame and even medication,” said Alhaji Ali Damaturu, Yobe’s State Coordinator, Network of People Living with HIV/AIDS (NEPWAN).

HIV and healthy babies

Alhaji Damaturu has 24 children that are HIV negative. Nine of them were born after he contracted the virus, but none of them has the virus because he and his three wives take their medications very seriously.

According to him: “Today, HIV/AIDS is like malaria. It can be overcome because there are several ways you can manage it and live your life normally without any problem.

“I have 24 children and three wives. I and my wives are all infected with the virus, but none of my children is HIV positive. We follow the counselling and take our drugs as and when due.

“We eat good food. I don’t joke with taking my drugs and my wives know that too. Look at us, we are happy. Out of these 24 children, nine were born after I got the virus, but not a single one of them is positive,” Ali declared.

ARVs can curb HIV spread

In fact, Bukola Alabi, Oyo State NEPWAN coordinator, said that with drugs, it is possible to be HIV-positive and yet the amount of this virus in the blood is not detected by a laboratory test.

“I’m HIV-positive. But thanks to drugs, no one can contract the virus from me.  The notion that HIV is not treatable is a myth. With daily effective antiretroviral therapy, I have an undetectable HIV load, and as such, I cannot infect other people,” Bukola declared.

HIV infection has spread over the last 30 years and has a great impact on health, welfare, employment and criminal justice sectors, affecting all social and ethnic groups throughout the world.

Recent studies show that HIV-positive people on antiretroviral therapy (ART) with stable undetectable viral load have an extremely low likelihood of transmitting the virus.

Benefits of undetectable viral load

One such study is PARTNER, in which 58,000 total acts of condom-less sex between members of heterosexual and gay sero-discordant couples (couples where one partner is living with HIV and the other is not) resulted in zero new HIV acquisitions.

The study recruited 1110 couples where the partners have differing HIV status – and nearly 40 per cent of them are gay couples. Couples have to be having sex without condoms at least some of the time.

The HIV-negative partner cannot be using post-exposure or pre-exposure prophylaxis (PEP or PrEP) and the HIV-positive partner has to be on ART, with the most recent viral load below 200 copies/ml.

PARTNER study’s principal investigator, Dr Jens Lundgren, pointed out that this meant that there was maximum five per cent chance that over a 10-year period, one in HIV-negative partners in a gay couple who had unprotected anal sex might acquire HIV; equally, though, it was more likely that their chance of acquiring HIV from their partner was nearer to zero, and indeed could be zero.

In 2011, a study, HPTN 052, had also established the efficacy of antiretroviral therapy in reducing HIV transmission from the HIV-positive partner to the HIV-negative one by at least 96 per cent in heterosexual couples. But, it had too few gay couples in it to establish if the same applied to them (or rather to anal sex).

CDC’s stand on undetectable viral load

More reassuringly, the U.S. Centres for Disease Control and Prevention (CDC) said that an HIV-positive person using daily antiretroviral therapy to maintain an undetectable viral load poses “effectively no risk” of sexually transmitting the virus to an HIV-negative partner.

CDC on its webpage stated: “Scientific advances have shown that antiretroviral therapy (ART) preserves the health of people living with HIV. We also have strong evidence of the prevention effectiveness of ART.

“When ART results in viral suppression, defined as less than 200 copies/ml or undetectable levels, it prevents sexual HIV transmission. Across three different studies, including thousands of couples and many thousand acts of sex without a condom or pre-exposure prophylaxis (PrEP), no HIV transmissions to an HIV-negative partner were observed when the HIV-positive person was virally suppressed.

“This means that people who take ART daily as prescribed and achieve and maintain an undetectable viral load have effectively no risk of sexually transmitting the virus to an HIV-negative partner.”

Undetectable viral load, prevention option

Executive Secretary, Oyo State Agency for the Control of AIDS (OYSACA), Mr Oba Oladapo, said attaining an undetectable HIV load is another powerful option in the HIV prevention toolbox that can be used in combination with other prevention options to stop the spread of the virus.

Oladapo stated that attaining an undetectable HIV load, however, does not mean that the individual has been cured of the virus.

He declared: “This only means that the anti-retroviral treatment is working, and that the amount of HIV in the blood is so low that even the best available tests cannot detect it.”

Nonetheless, Mr Oladapo emphasised that everybody should be tested so that those with HIV will know it, and those that test positive can access treatment.

He declared: “Everybody on treatment needs to be sustained on treatment to the extent of attaining an undetectable viral load. By so doing, such an individual cannot infect another person with HIV. This is important to put an end to HIV.”

Undetectable viral load, not a substitute for condom

The idea of living with an “undetectable” virus is dramatically reshaping the HIV-positive community. But does this infer no condom use?

However, researchers involved in the PARTNER study did not recommend that undetectable gay and bi men have sex without the usual methods of protection, for example, condoms.

More importantly, using a condom will prevent sexually transmitted infections other than HIV. Cases of Chlamydia, gonorrhoea, and syphilis, for instance, in the U.S. had reached their highest level ever.

In addition, there are emerging new STDs including Ebola virus and Zika virus. Cases have been reported where Zika is shed in the semen for months after infection. Hepatitis C virus has also emerged as an important STD, with condom-less anal sex being one of several risk factors.

Of course, HIV that is undetectable can become detectable for a variety of reasons, including missing doses of antiretrovirals and concurrent illnesses.

Rare cases of HIV infection can occur even when viral load is suppressed. Studies have shown that some men can have detectable HIV in their semen even when blood plasma viral load is below the limit of detection.