Undetectable HIV Equals Untransmittable HIV (U = U) Statement in Women. Are we there Yet?
Justyna D Kowalska1,2, Dagny C Krankowska3*, Agnieszka Wróblewska2 and Ewa Firląg-Burkacka2
1Department of Adults’ Infectious Diseases, Medical University of Warsaw, Poland
2HIV Out-Patient Clinic, Hospital for Infectious Diseases, Warsaw, Poland
3Department of Infectious and Tropical Diseases and Hepatology, Medical University of Warsaw, Hospital for Infectious Diseases, Warsaw, Poland
*Corresponding Author: Dagny C Krankowska, Department of Infectious and Tropical Diseases and Hepatology, Medical University of Warsaw, Hospital for Infectious Diseases, Warsaw, Poland.
Received:
April 08, 2022; Published: May 17, 2022
Abstract
Introduction: The “undetectable equals untransmittable” (U = U) statement confirms that a HIV positive person on effective antiretroviral therapy is not transmitting HIV to his/her sexual partner. Poor adherence to treatment can jeopardize this benefit. Women living with HIV (WLWH) are more at risk of having suboptimal adherence than men.
Objectives: To compare the characteristics of women on effective cART with those who have a detectable HIV viral load (VL), in order to understand the differences in behavioral patterns and to better address the U = U statement among women.
Methods: Women with HIV using gynecological services in the Out-Patient Clinic in Warsaw participated in a survey about sexual behavioral patterns and history of sexually transmitted infections (STIs). The data about HIV VL, status of HCV, HPV and other STIs was exported from the medical database. Characteristics of women with HIV RNA>50 copies/ml and women with HIV RNA<50 copies/ml were compared using non-parametric tests as appropriate.
Results: The study included 97 WLWH with median age 39 years and 82 (84.5%) with undetectable HIV VL. The median number of sexual partners in both groups was five (IQR: 3.5-8.5 and 3-10 for those with VL<50 and VL>50 respectively). Most characteristics were comparable between study groups except that more women with detectable VL did not use condoms (66.7% vs. 39%, p = 0.0244).
Conclusions: More attention should be drawn to reasons of poor adherence to cART in WLWH. Same efforts in educating about safe sex and U = U should be made in WLWH as for other key populations.
Keywords: HIV; cART; Undetectable; Untransmittable; Adherence; Women
References
- Cohen MS., et al. “Antiretroviral Therapy for the Prevention of HIV-1 Transmission”. The New England Journal of Medicine 9 (2016): 830-839.
- Prevention Access Campaign. Prevention Access Campaign website (2020).
- Okonsky J., et al. “Appreciating Reasons for Nonadherence in women”. Health Care Women International9 (2015): 1007-1025.
- Tsega B., et al. “Determinants of non-adherence to antiretroviral therapy in adult hospitalized patients, Northwest Ethiopia”. Patient Preference and Adherence 9 (2015): 373-380.
- Hadayye RS., et al. “Assessment of adherence and factors contributing to non-adherence among patients on anti-retroviral therapy in a tertiary care hospital: A cross sectional study”. Journal of Family Medicine and Primary Care 4 (2020): 1921-1926.
- “Latest HIV estimates and updates on HIV policies uptake”. July (2020).
- Lopez EJ., et al. “Violence, coping and consistent medication adherence in HIV-positive couples”. AIDS Education Prevention1 (2010): 61-68.
- Johnson M., et al. “Barriers to access to care reported by women living with HIV across 27 countries”. AIDS Care10 (2015): 1220-1230.
- Duff P., et al. “Severe menopausal symptoms associated with reduced adherence to antiretroviral therapy among perimenopausal and menopausal women living with HIV in Metro Vancouver”. Menopause 5 (2018): 531-537.
- Maki PM., et al. “Depressive Symptoms are Increased in the Early Perimenopausal Stage in Ethically Diverse HIV+ and HIV- Women”. Menopause 11 (2012): 1215-1223.
- Ward H and Ronn M. “The contribution of STIs to the sexual transmission of HIV”. Current Opinion in HIV and AIDS 4 (2010): 305-310.
- The INSIGHT START Study Group. “Initiation of Antiretroviral Therapy in Early Asymptomatic HIV Infection”. The New England Journal of Medicine9 (2015): 795-807.
- Rodger AJ., et al. “Risk of HIV transmission through condomless sex in sero different gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study”. Lancet 393 (2019): 2428-2438.
- Bavinton BR., et al. “Viral suppression and HIV transmission in serodiscordant male couples: an international, prospective, observational, cohort study”. The Lancet8 (2018): 438-447.
- Parczewski M., et al. “Meeting the WHO 90% target: antiretroviral treatment efficacy in Poland is associated with baseline clinical patient characteristics”. Journal of the International AIDS Society 1 (2017): 21847.
- Okoli C., et al. “Undetectable equals untransmittable (U=U): awareness and associations with health outcomes among people living with HIV in 25 countries”. Sexually Transmitted Infections 97 (2021): 18-26.
- Balayan T., et al. “People who inject drugs remain hard-to-reach population across all HIV continuum stages in Central, Eastern and South Eastern Europe - data from Euro-guidelines in Central and Eastern Europe Network”. Infectious Diseases4 (2019): 277-286.
- Roberts KJ and Mann T. “Adherence to antiretroviral medications in HIV/AIDS care: a narrative exploration of one woman's foray into intentional nonadherence”. Health Care for Women International 6 (2003): 552-564.
- Gay C., et al. “Self-reported medication adherence and symptoms experience in adults with HIV”. Journal of the Association of Nurses in AIDS Care 22 (2011): 257-268.
- Kyser M., et al. “Factors associated with nonadherence to antiretroviral therapy in the SUN study”. AIDS Care 23 (2011): 601-611.
- “The People Living with HIV Stigma Index (STIGMA Index) Project. HIV-related stigma: late testing, late treatment. A cross analysis of findings from the people living with HIV Stigma Index in Estonia, Moldova, Poland, Turkey, and Ukraine” (2010).
- Aebi-Popp K., et al. “Postnatal retention in HIV care: insight from the Swiss HIV cohort study over a 15-year observational period”. HIV Medicine 17 (2016): 28028814.
- Andany N., et al. “Prevalence and correlates of early-onset menopause among women living with HIV in Canada”. Menopause 1 (2020): 66-75.
- Altice F., et al. “Adherence to HIV treatment regimens: systematic literature review and meta-analysis”. Patient Prefer Adherence 13 (2019): 475-490.
- Kowalska JD., et al. “A current HCV infection may increase the risk of preterm birth among HIV-positive women”. Sexually Transmitted Infections 5 (2020): 335336.
- Kowalska JD., et al. “Barriers to cervical cancer screening exist despite integrating HIV and gynecological services for HIV-positive women in Poland”. Ginekologia Polska2 (2018): 68-73.
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