New HIV guidelines on viral suppression unveiled at international AIDS conference
The World Health Organization (WHO) released new scientific and normative guidance for human immunodeficiency virus (HIV) at the 12th International International AIDS Society Conference on HIV Science on July 23, 2023.
The United Nations’ health agency also recommended countries integrate mpox detection, prevention and care with existing and innovative HIV and sexually transmitted infection prevention and control programmes.
The new recommendations, accompanied by a systematic review published in the journal The Lancet, shed light on the critical role of HIV viral suppression and undetectable virus levels in enhancing individual health and preventing transmission of the virus.
Over 82,000 mpox cases were reported to the WHO, found an analysis of global surveillance data during the 2022-2023 multi-country outbreak of mpox. Of these cases, around 32,000 cases had information on HIV status.
Among those, 52 per cent were living with HIV, most being men who have sex with men (MSM). More than 80 per cent of them reported sex as the most probable route of getting infected with mpox.
Around one quarter (25 per cent) had advanced HIV disease or immunosuppression — leading to an increased risk of hospitalisation and death. People living with HIV who were taking the treatment and with good immunity had similar hospitalisation and death outcomes as those who were HIV negative.
The WHO guidelines described key HIV viral load thresholds as well as methods for measuring virus levels in relation to these thresholds.
People living with HIV, for example, who achieve an undetectable level of virus through consistent use of antiretroviral therapy (ART) do not transmit HIV to their sexual partner(s) and are at low risk of vertically transmitting HIV to their children.
The evidence also suggests that there is a negligible, or nearly zero, risk of transmitting HIV when a person has a viral load measurement of less than or equal to 1000 copies per mL, also known as having a suppressed viral load, according to the WHO.
An estimated 40 million people living with HIV globally depend on a cocktail of drugs to suppress the viral load in their blood. The drugs, known as ART, delay the progression of the infection into acquired immunodeficiency syndrome (AIDS) and result in fatal consequences.
The global health organisation also stated that ART is still transforming the lives of people living with HIV. People living with HIV who are diagnosed and treated early and who take their medication as directed can expect to have the same health and life expectancy as HIV-negative peers.
“For more than 20 years, countries all over the world have relied on WHO’s evidence-based guidelines to prevent, test for and treat HIV infection,” said Tedros Adhanom Ghebreyesus, WHO director-general.
“The new guidelines we are publishing today will help countries to use powerful tools have the potential to transform the lives of millions of people living with or at risk of HIV,” Ghebreyesus added.
Meanwhile, to understand how to better prepare for and respond to future increases in mpox transmission, WHO led a rapid electronic survey in May 2023 to assess community experiences of the mpox outbreak in Europe and the Americas.
More than 24,000 people participated in the survey, which focused on men who have sex with men and trans and gender-diverse people, with 16,875 eligible individuals completing the survey.
Almost 51 per cent changed their sexual behaviour (such as reducing the number of sexual partners) and 35 per cent had maintained these changes one year later.
The findings from this survey provide valuable insights into the experiences and needs of affected communities and emphasise the importance of increasing access to mpox vaccination and diagnostics globally.
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