A new meta-analysis published in Public Health provides compelling evidence that antiretroviral therapy (ART) effectively prevents HIV transmission among serodiscordant couples in high-income countries, reinforcing the concept of treatment as prevention.
The systematic review examined data from six studies primarily conducted in Europe and Australia, encompassing 2,383 couples over 3,578 couple-years. While 19 HIV transmissions were documented during the study period, none were linked to index partners enrolled in the research, demonstrating the remarkable effectiveness of ART in preventing viral transmission.
Statistical Evidence of Treatment Effectiveness
The analysis revealed striking results across different demographic groups. The overall HIV transmission risk was calculated at 0.00 (95% CI, 0.000-0.103) per 100 couple-years. Similar results were observed in both heterosexual couples (0.00; 95% CI, 0.000-0.264) and men who have sex with men (0.00; 95% CI, 0.000-0.169), with zero statistical heterogeneity across all analyses.
Clinical Implications and Treatment Context
ART's role in HIV management has evolved significantly since its FDA approval in 1987, with highly active ART becoming available in 1996. Study co-author Emma Grundtvig Gram emphasized the findings' significance, stating, "This new review supports the 'treatment as prevention' theory that HIV cannot be transmitted if the person is undergoing treatment. This points to the fact that it can be considered safe to have sexual intercourse with someone who is HIV-positive and in treatment."
Study Parameters and Limitations
The research focused on couples where one partner was HIV-positive and on ART, while the other was HIV-negative and not using pre-exposure prophylaxis. The findings primarily apply to individuals with viral loads below 200 copies/mL and who have been on treatment for at least six months, even with adherence rates as low as 60%.
Policy Implications and Future Directions
The researchers advocate for systemic changes in how healthcare institutions and society approach HIV-positive individuals. "To reduce HIV incidence and improve the management of prevalent infections, it might be a wise strategy to gradually remove institutional stigmas and discriminatory barriers faced by people with HIV and their non-infected partners," the authors noted in their conclusions.
These findings could have far-reaching implications for healthcare policies, including potential revisions to blood donor eligibility criteria and other institutional practices affecting HIV-positive individuals.
