A survey of specialist staff working in HIV in the UK shows that most do now inform people with HIV that if their viral load becomes undetectable as a result of taking antiretroviral therapy, they can no longer transmit the virus ('Undetectable equals untransmittable', or 'U=U'). However, the healthcare workers told the patients at different times and also phrased the information in different ways.
Sixty-nine per cent of respondents said they discussed U=U when patients were diagnosed and 55% talked about it when people start treatment, 48% when patients become undetectable and 38% said they talked about it when patients are fully adherent. It’s clear that some clinicians may discuss U=U with a patient on several occasions, but others seem to only raise it when they feel sure that the person is at no risk of transmitting HIV. Three per cent of the respondents said they discussed U=U only if asked and 2% said they did not discuss it all.
The inconsistent practice has prompted the British HIV Association (BHIVA, the professional body for HIV clinicians) to advise its members to discuss U=U with all people living with HIV throughout their care.
BHIVA says: “We recommend consistent and unambiguous terminology when discussing U=U such as 'no risk' or 'zero risk' of sexual transmission of HIV, avoiding terms like 'negligible risk' and 'minimal risk'."
For more information, read NAM's 'Undetectable viral load and transmission – a factsheet for people with HIV'.