U=U and More!
The International AIDS Society meeting in Paris in July was full of good news. Probably the most exciting message for those with HIV was that U=U, meaning undetectable equals untransmissable, a message delivered by Dr Andrew Grulich from the Kirby institute in Sydney. He was reporting on the results of the “Opposites Attract” study, which looked at HIV transmission in several hundred gay male couples in Australia, Brazil and Thailand, where only one partner had HIV and was on treatment and undetectable. Note that the negative partners in this study were not on PrEP.
The study showed that in over 12,000 acts of condomless anal sex in the study group, there were zero linked transmissions of HIV if the positive partner was undetectable. Zilch. Not a single one.
That’s so convincing that the message has been overwhelmingly taken up by both medical groups and advocacy groups. One group of HIV activists marched through conference sessions with banners chanting “U=U”.
Anyone who is HIV positive and undetectable should now feel very confident that they are not infectious and cannot transmit the virus to their partner.
The other big message was about PrEP, the pill you take to protect against HIV infection. A presentation of all the big studies around the world including the British PROUD study and the French IPERGAY study showed that PrEP using Truvada is highly effective, and there is increasing evidence that “on-demand” PrEP, i.e. taken only when needed before and after sex, is also protective, although more evidence needs to be presented about this, and dosages and timing will be different for women. Current PrEP studies in Australia, including QPrEP in Queensland, are following the Australian guidelines, and are not recommending anything other than daily use at present.
There are injectable products being investigated for PrEP, but these are not yet available.
Finally, in 30 years of drug development for HIV, we are still seeing the approval of new antivirals with great efficacy and fewer side effects. There’s likely to be a new single pill coming our way perhaps in 2018, with no booster in it, and a long-acting injectable treatment is also not far away.
Overall these were very positive messages for us here in Australia. Sadly there are still millions of people with HIV in other countries who do not have access to medications, and we can’t start celebrating the end of HIV/AIDS until all individuals the world over have access to PrEP and safe and effective HIV treatment.