Antiretroviral therapy (ART) has advanced considerÂably, from the approval of zidovudine (AZT) in 1987 through the emergence of triple-drug therapy and single-tablet regimens.1,2 Newer agents have fewer adverse effects and provide a life expectancy similar to individuals without HIV infection.3 With clear mortality benefits linked to ART, attention has now turned to the benefits of ART in preventing HIV transmission. HIV treatment as prevenÂtion (TasP) has now become an important part of the HIV prevention toolbox.
The Undetectable Equals Untransmittable, or U=U, moveÂment is a global campaign definitively stating that people living with HIV (PLWH) who have undetectable HIV RNA are unable to transmit HIV.5 By educating people, the hope is that they will get tested and, if necessary, start and stay on treatment. This message has been endorsed by many organizations, including the US Centers for Disease Control and Prevention6 and the HIV Medicine Association.
For many PLWH, the message of U=U can be life changing. This message that they are not able to transmit the virus if they have undetectable HIV RNA removes some of the stigma of living with HIV. Some patients may have chosen to completely avoid relationships for fear of transÂmission, but they now can have a feeling of empowerment to make decisions in their own sexual relationships. The U=U message may allow them to feel comfortable pursuing relationships. For health care providers, the U=U moveÂment gives them evidence to present to patients in support of starting therapy. In addition to the mortality benefits patients will receive from ART and achieving virologic suppression, there are transmission benefits to their partÂners and the general public. Patients are playing their own part in ending the HIV epidemic.
FOUR STUDIES SUPPORT U=U
There have been 4 main studies providing data behind the U=U movement. Each builds on the next, with U=U becoming more and more definitive. Although they all have slightly different populations and inclusion criteria, in each study, transmissions were essentially zero.