Undetectable Equals Untransmittable

Antiretroviral therapy (ART) has advanced consider­ably, 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 preven­tion (TasP) has now become an important part of the HIV prevention toolbox.

The Undetectable Equals Untransmittable, or U=U, move­ment 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 trans­mission, 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 move­ment 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 part­ners 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.

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During the Canada Post strike announced September 25, 2025, the following measures will be undertaken to minimize service disruption to BC-CfE clients and providers.

  • The BC-CfE Laboratory has transitioned to private courier for delivery of outgoing reports and documents. Results required urgently can be faxed upon request. (Lab Contact Information: Phone 604-806-8775; FAX 604-806-9463)
  • The BC-CfE Drug Treatment Program (DTP) will fax outgoing forms and documents to the provider’s office. (DTP Contact Information: Phone 604-806-8515; FAX 604-806-9044)
  • St. Paul’s Hospital Ambulatory Pharmacy has transitioned to private courier for delivery of medications. We recommend requesting medication at least 2 weeks in advance in case of delivery delays, particularly to rural/remote parts of BC. (Contact Information: Phone 1-800-547-3622; FAX 604-806-8675)

During the Canada Post strike, we recommend that documents be faxed or couriered to our sites, versus utilization of regular mail service

The BC-CfE Laboratory is streamlining reporting processes for certain tests in order to simplify distribution and record-keeping, and to ensure completeness of results. Beginning September 2, 2025, results for the ‘Resistance Analysis of HIV-1 Protease and Reverse Transcriptase’ (Protease-RT) and ‘HIV-1 Integrase Resistance Genotype’ tests will be combined into a single ‘HIV-1 Resistance Genotype Report’.
For more details and example reports, please click on the button below

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