Risk of HIV transmission negligible if taking ART with viral load < 200 copies/mL

Référence

LeMessurier J, Traversy G, Varsaneux O, et al. Risk of sexual transmission of human immunodeficiency virus with antiretroviral therapy, suppressed viral load and condom use: a systematic review. CMAJ 2018;190(46):E1350-E1360.

Sommaire

This study was motivated by a Canadian law that criminalizes when an HIV positive person engages in sexual activity without disclosure when there is a "realistic possibility" of transmission. Given that most patients living with HIV infection in Canada are now taking antiretroviral therapy and have suppressed viral loads, how likely is transmission? This was a well-done systematic review that searched all relevant databases for previous systematic reviews, as well as for newer studies published since. They identified 12 previous systematic reviews, and used 11 in their updated meta-analysis (one randomized trial and 10 observational studies). Overall, the quality of evidence was felt to be moderate to high. For patients who are taking ART and have a viral load of less than 200 copies/mL, the risk of transmission for heterosexual couples and women who have sex with women was 0.0 per 100 person-years (95% CI 0.00 - 0.46); the risk for men who have sex with men was also 0.00 per 100 person-years (0.00 - 0.70). The overall risk was 0.00 per 100 person-years (0.00 - 0.28). Rates were similar for patients who were using ART regardless of viral load who were also using a condom. For condom use alone, the risk of transmission for heterosexual couples was 1.14 per 100 person-years (0.56 - 2.04). There was no direct evidence for patients taking ART with suppressed viral load who were also using condoms. Note that, in the studies, viral load was measured every 4 to 6 months.