Brief Report: Undetectable HIV-1 Viral Load Among Virally Suppressed People Living With HIV: Implications For Undetectable Equals Untransmittable (U=U) in Resource-Limited Settings Using Dried Spot Testing.

Details

• Alternative Title:
  Journal of Acquired Immune Deficiency Syndromes (1999), 2025, v. 100, no. 4: Brief Report: Undetectable HIV-1 Viral Load Among Virally Suppressed People Living With HIV: Implications For Undetectable Equals Untransmittable (U=U) in Resource-Limited Settings Using Dried Spot Testing.
• Journal Article:
  Journal of Acquired Immune Deficiency Syndromes (1999)
• Personal Author:
  Chang, Gregory C. ; Bingham, Trista ; Patel, Hetal K. ; Mungai, Elisabeth ; Sleeman, Katrina ; Benech, Irene ; Selenic, Dejana ; Metz, Melissa ; Duong, Yen T. ; Saito, Suzue ; Shang, Judith ; Dokubo, Emily K. ; Eno, Laura ; Motsoane, Tsietso ; Ryan, Caroline ; Auld, Andrew ; Kim, Evelyn ; Maida, Alice ; Malewo, Optatus ; Juma, James M. ; Awor, Anna Colletar ; Kancheya, Nzali ; Ndongmo, Clement B. ; Balachandra, Shirish ; Getaneh, Yimam ; Lulseged, Sileshi ; Eshetu, Frehywot ; Young, Peter W. ; Williams, Daniel B. ; West, Christine ; Justman, Jessica ; Parekh, Bharat S. ; Voetsch, Andrew C.
• Description:
  The Undetectable=Untransmittable (U=U) campaign, grounded in strong scientific evidence, affirms that people living with HIV (PLHIV) with an undetectable viral load (VL), defined as ≤50 copies per milliliter (c/mL) or <200 c/mL of HIV RNA, do not transmit HIV to sexual partners. In resource-limited settings, VL is commonly measured using dried blood spot (DBS) testing, which has a higher limit of detection (550-1000 c/mL). We report the proportion of PLHIV with VL <1000 c/mL who also had VL <200 c/mL and ≤50 c/mL to inform interpretation of DBS VL results under U=U.
  
  We analyzed data from 13 cross-sectional nationally representative surveys (2015-2019), including PLHIV aged 15-59 years receiving antiretroviral therapy (ART) with valid plasma VL results. We estimated the proportion of participants with VL <200 c/mL and ≤50 c/mL among those with VL <1000 c/mL, overall and among those on ART ≥12 months using survey weights.
  
  Among 16,533 PLHIV across 13 countries, 87.3% had VL <1000 c/mL. For PLHIV with VL <1000 c/mL, 95.4% had VL <200 c/mL and 84.9% had VL ≤50 c/mL. Among those on ART ≥12 months, 96.6% had VL <200 c/mL, and 87.4% had VL ≤50 c/mL.
  
  Most PLHIV with VL <1000 c/mL had a VL <200 c/mL and ≤50 c/mL, indicating no risk of sexual HIV transmission. Our findings provide evidence that in settings relying on DBS VL testing, most PLHIV with VL <1000 c/mL likely fall below 200 c/mL or are undetectable based on the assay's lower limit of detection.
• Content Notes:
  Author manuscript
• Subjects:
  • Humans
  • Viral Load
  • HIV Infections
  • Adult
  • Male
  • Middle Aged
  • Female
  • Cross-Sectional Studies
  • HIV-1
  • Dried Blood Spot Testing
  More +
• Keywords:
  • HIV infection
  • viral load
  • dried blood spot testing
  • plasma
  • prevention
  • HIV transmission
• Source:
  Journal of Acquired Immune Deficiency Syndromes (1999), 2025, v. 100, no. 4
• DOI:
  https://doi.org/10.1097/QAI.0000000000003745
• ISSN:
  1525-4135 ; 1944-7884
• Pubmed ID:
  40815535
• Pubmed Central ID:
  PMC13047505
• Document Type:
  Text
• Funding:
  U2G GH001226/GH/CGH CDC HHSUnited States/
• Genre:
  Journal Article
• Pages in Document:
  289-293 (9 pdf pages)
• Volume:
  100
• Issue:
  4
• Download URL:
  https://stacks.cdc.gov/view/cdc/261170/cdc_261170_DS1.pdf
• File Type:
  [PDF - 80.14 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:471b9299c67e1ed0671c8046aab7d58fdf0a8ce14563e590d7ba21583202a9156b0d8a00f3829afbc9082308d887013da4cb30aca04ac5fb16f53fd43f1fe065