Brief Report: Undetectable HIV-1 Viral Load Among Virally Suppressed People Living With HIV: Implications for Undetectable Equals Untransmittable (U=U) in Resource-Limited Settings Using Dried Spot Testing
Year: 2025
Type: article
Abstract: BACKGROUND: The Undetectable=Untransmittable (U=U) campaign, grounded in strong scientific evidence, affirms that people living with HIV (PLHIV) with an undetectable viral load (VL), defined as ≤50 copies per milliliter (c/mL) or <200 c/mL of HIV RNA, do not transmit HIV to sexual partners. In resource-limited settings, VL is commonly measured using dried blood spot (DBS) testing, which has a higher limit of detection (550-1000 c/mL). We report the proportion of PLHIV with VL <1000 c/mL who also had VL <200 c/mL and ≤50 c/mL to inform interpretation of DBS VL results under U=U. METHODS: We analyzed data from 13 cross-sectional nationally representative surveys (2015-2019), including PLHIV aged 15-59 years receiving antiretroviral therapy (ART) with valid plasma VL results. We estimated the proportion of participants with VL <200 c/mL and ≤50 c/mL among those with VL <1000 c/mL, overall and among those on ART ≥12 months using survey weights. RESULTS: Among 16,533 PLHIV across 13 countries, 87.3% had VL <1000 c/mL. For PLHIV with VL <1000 c/mL, 95.4% had VL <200 c/mL and 84.9% had VL ≤50 c/mL. Among those on ART ≥12 months, 96.6% had VL <200 c/mL, and 87.4% had VL ≤50 c/mL. CONCLUSION: Most PLHIV with VL <1000 c/mL had a VL <200 c/mL and ≤50 c/mL, indicating no risk of sexual HIV transmission. Our findings provide evidence that in settings relying on DBS VL testing, most PLHIV with VL <1000 c/mL likely fall below 200 c/mL or are undetectable based on the assay's lower limit of detection.
Authors: Gregory C. Chang, Trista Bingham, Hetal K. Patel, Elisabeth Mungai, Katrina Sleeman, Irene Benech, Dejana Selenic, Melissa Metz, Yen T. Duong, Suzue Saito, Judith Shang, Emily K. Dokubo, Laura Eno, Tsietso Mots'oane, Caroline Ryan, Andrew Auld, Evelyn Kim, Alice Maida, Optatus Malewo, James M. Juma, Anna Colletar Awor, Nzali Kancheya, Clement B. Ndongmo, Shirish Balachandra, Yimam Getaneh, Sileshi Lulseged, Frehywot Eshetu, Peter W. Young, Daniel B. Williams, Christine West, Jessica Justman, Bharat S. Parekh, Andrew C. Voetsch
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4413137762