by Jeffrey T. Kirchner, DO, AAHIVS, AAHIVM Chief Medical Officer

January 21, 2020

Featured Literature:

R. Stephenson, et al. Accuracy in self-report of viral suppression among HIV-positive men with HIV-negative male partners. Journal of Acquired Immune Deficiency SyndromesJanuary 07, 2020 – published ahead of print. doi: 10.1097/QAI.0000000000002240

The U=U campaign has promoted the science and clinical implications regarding viral suppression and non-transmissibility of HIV. However, there is little data regarding how this information is communicated from HIV-positive MSM to their partners. This study used data from “Stronger Together” which is an efficacy trial of adherence interventions with MSM living in Atlanta, Boston, and Chicago who are in serodiscordant relationships. The authors combined patient self-reporting and biomarker-confirmed measures to assess the accuracy of self-report of viral load suppression. Among this group only 73% of men could accurately report their viral load status. In addition, 20% reported that they were virally suppressed when they actually had no biomarker confirmed measure of their viral load. The authors note these results confirm the findings of other recent studies in which there was a great deal of inaccuracy among patients reporting viral suppression. They cite the need for collaborative interventions to help the infected partner in serodiscordant relations adhere to medical therapy and maintain an undetectable viral load, thus applying the strategy of U=U.

Author’s Commentary:

The authors note in their conclusion that this study highlights the need to regularly provide patients with information regarding their viral loads. Continuous access to medical care including ART along with periodic lab monitoring are key components of keeping patients undetectable and untransmittable. However, promotion of condom use and PrEP may still have a role in serodiscordant relationships and are important educational issues. Engaging the HIV-negative partner, as is being done with the “Stronger Together” trial, may be possible as a model of care in some clinics.

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