Proper management of problems such as anxiety, depression, or problematic substance use would also be necessary to help reduce the rate of transmissions.

The fact that people with HIV maintain good levels of adherence to their medical follow-up visits could translate into a lower average viral load and, consequently, a reduction in the number of HIV transmissions at the population level, according to suggest the conclusions of a theoretical study published in the Journal of the International AIDS Society.

It is a widely known and recognized fact by the highest scientific bodies that people with HIV with an undetectable viral load thanks to antiretroviral treatment cannot transmit the infection sexually.


It is the concept known as ‘undetectable equals untransmittable’ or I = I. However, the way in which this concept can be transferred to the population level has not yet been analyzed in depth, taking into account the existence of subgroups of people with HIV who, due to various circumstances, do not undergo adequate medical follow-up or do not maintain adequate medical care. good level of adherence to your treatment.

To shed some more light on this issue, the authors of this study started from the medical records of 14,261 people with HIV seen in various American medical centers between 2007 and 2017. These records analyzed viral load, number of follow-up visits of HIV and the presence of anxiety, depression and problematic use of alcohol and / or drugs. Data were also obtained on the number of sexual partners in the previous six months and on the use of condoms in these practices.

From these data, the researchers generated a model to calculate the risk of HIV transmission at each time point.

The 14,261 people with HIV on antiretroviral treatment included in the study made 61,198 follow-up visits for their HIV infection during the follow-up period. 58% of the participants were white and 33% were black. 84% were cis men and 17% were women (of which 163 were trans). 54% of the total were gay, bisexual and other men who have sex with men (GBHSH). The median age was 44 years.

At the first visit, 76% of the participants had virological suppression (viral load less than 400 copies / mL). This varied according to the group (80% in heterosexual men, 76% in GBHSH, 77% in trans women, and 75% in cis women).

At the start of the study, 46% of the participants met diagnostic criteria for depression. 25% reported anxiety symptoms, 24% reported problematic alcohol use, and 15% reported the use of recreational drugs such as amphetamines, cocaine, heroin, and other opioids. The longer a patient stayed in medical follow-up, the lower their viral load and, therefore, their risk of transmitting HIV. The same phenomenon was observed in relation to the risk of suffering from anxiety, depression or problematic substance use.


At the end of the study, the overall virologic suppression rate increased to 85% (88% in cis heterosexual men, 86% in GBHSH, 86% in trans women, and 82% in cis women).

At the start of the study, the researchers estimated that there were 0.83 HIV transmissions per 100 participants annually. As they remained in follow-up and on treatment, the model predicted that this rate would decrease to 0.38 annual transmissions per 100 participants. Each medical visit a participant attended was associated with a decrease of 0.05 annual HIV transmissions per 100 participants.

However, this dynamic was modified by the coexisting conditions evaluated in the study (anxiety, depression, problematic alcohol use and substance use). Thus, people who did not have any of the evaluated conditions had a transmission risk at the end of the study of 0.19 annual HIV transmissions per 100 participants. On the other hand, if said person had all four conditions, their risk of transmission increased to 1.32 annual HIV transmissions for every 100 participants

The prevalence of coexisting conditions varied greatly depending on the population subgroup, which produced important differences. Thus, while in cis women 0.25 annual HIV transmissions were estimated per 100 participants, in trans women, given their high prevalence of coexisting conditions, 2.21 annual HIV transmissions were estimated per 100 participants. The same phenomenon was observed in GBHSH, where the presence of the four coexisting conditions implied a rate of 1.83 annual HIV transmissions per 100 participants.

The results of the present study highlight the importance of good adherence to HIV medical follow-up - which tends to go hand in hand with good adherence to treatment - in reducing the risk of HIV transmission in the community. In addition, offering an adequate diagnosis and management of anxiety, depression and problematic substance use could enhance the reduction of HIV transmission.


Source: POZ / Own Elaboration (gTt-VIH).
References: Satyanarayana S, Safren SA, Rogers BG, et al. Estimating HIV transmissions in a large U.S. clinic-based sample: effects of time and syndemic conditions. J Int AIDS Soc. 2021 Mar;24(3):e25679. doi: 10.1002/jia2.25679. PMID: 33724718; PMCID: PMC7962793.

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