The study reinforces the I = I message and identifies those subgroups for whom it is more difficult to maintain control and, therefore, to whom adherence support programs should target

A study published in AIDS that has carried out long-term monitoring of people with HIV and controlled viral load has concluded that these people rarely lose virological control, which reinforces the message of 'undetectable equals untransmittable' or I = I. The study included the participation of more than 8,000 people in antiretroviral treatment in a state of virological suppression - defined as a viral load of less than 200 copies / mL.


In the study, the viral load of these people remained in a virological suppression state 97% of the time, although some subgroups - women, intravenous drug users and people with a history of virological failure - were detected who would be at greater risk of loss of virological suppression.

Today there is clear scientific evidence that people with HIV on antiretroviral treatment and viral loads below 200 copies / mL cannot transmit HIV to their sexual partners. For some years now, the I = I message has been permeating society - especially within the HIV community - and numerous scientific societies and community organizations have given and continue to support the I = I concept. all the underlying science.

However, in case some people had doubts about whether all people in a virological suppression state –with viral loads below 200 copies / ml– manage to stay below this threshold among their routine tests, Italian researchers designed a study that could offer an answer with real life data. To do this, they analyzed data on virological suppression of people with HIV on antiretroviral treatment from the ICONA study, a cohort that carries out epidemiological and clinical follow-up of patients with HIV in Italy. The inclusion criteria were having a viral load less than 200 copies / mL for a minimum of 6 months. The study period was between 2010 and 2019.

The main objective was to determine the percentage of time (person-days of follow-up) during which the participants maintained virological suppression. This was determined by analyzing the results of consecutive viral load tests and attributing the period between them to "maintenance of virological suppression" if both were below 200 copies / mL or to "virological rebound" if the threshold was exceeded in these two tests. of the 200 copies / mL. In cases in which one analytical was above 200 copies / mL and the other was below this figure, the period was divided equally between the two periods described above.


A total of 8,241 people were included. One fifth were women; 46% were gay, bisexual and other men who have sex with men (GBHSH); 39% were heterosexual people and 9% were intravenous drug users. 25% of the participants were people of foreign origin. At baseline, the median age was 39 years and the CD4 count was 545 cells / mm3. 91% of the participants had never experienced virological failure; 5% had experienced it between one and three times and 4% more than three times.

During follow-up, each participant had a median of 9 viral load measurements (an average of 2.5 per year of follow-up). Participants accumulated a total of 12,670,888 person-days of follow-up. During 96.9% of the follow-up, the participants had a viral load of less than 200 copies / mL. Only 3.1% of the time these people were above this figure; This percentage was reduced to 2.5% when including only those people with at least two annual viral load measurements.

The percentage of days without virological suppression was the highest in 2013 and steadily declined in subsequent years. The researchers identified that the percentage of time without virological suppression was higher than average in women (5.3%), foreigners (5.4%), unemployed (5.4%), intravenous drug users (4.7%) and people with more than three previous episodes of virological rebound (6.3%).

In a second analysis, participants were categorized as "out of virological control" if they had spent more than 10% of the time with a viral load above 200 copies / mL. According to this analysis, 92.5% of the participants maintained their virological control during the study. Of the remaining 7.5%, most only had one or two viral load results greater than 200 copies / mL.

The results of the present study show, once again, the robustness of the I = I message and help to identify which groups could benefit the most from adherence support programs to increase - even more - the percentage of people in virological suppression, for the benefits that are obtained both for individual health and for the population.


Source: Aidsmap / Elaboración propia (gTt-VIH).
References: Madeddu G et al. Time spent with a viral load <200 copies/mL in a cohort of people with HIV seen for care in Italy during the U=U prevention campaign era. AIDS, published online ahead of print, 29 January 2021.

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