Abstract
In the last decade, reliable scientific evidence has emerged to support the concept that undetectable viral loads prevent human immunodeficiency virus (HIV). Undetectable equals untransmissible (U = U) is a simple message that everyone can understand. The success of this concept depends on strict adherence to antiretroviral therapy (ART) and the attainment of suppressed viral loads (VLs). To achieve U = U in sub-Saharan Africa (SSA), poor adherence to ART, persistent low-level viremia, and the emergence of drug-resistant mutants are challenges that cannot be overlooked. Short of a cure for HIV, U = U can substantially reduce the burden and change the landscape of HIV epidemiology on the continent. From a public health perspective, the U = U concept will reduce stigmatization in persons living with HIV (PLWHIV) in SSA and strengthen public opinion to accept that HIV infection is not a death sentence. This will also promote ART adherence because PLWHIV will aim to achieve U = U within the shortest possible time. This article highlights challenges and barriers to achieving U = U and suggests how to promote the concept to make it beneficial and applicable in SSA. This concept, if expertly packaged by policy-makers, clinicians, health service providers, and HIV control programs, will help to stem the tide of the epidemic in SSA.
Highlights
Since the discovery of the human immunodeficiency virus (HIV), the search for effective treatment and cure has occupied the scientific community
AZT brought a lifeline to persons living with HIV (PLWHIV) as it reduced the HIV viral loads (VLs) and delayed progression to full-blown AIDS [2,3]
The sustained ability of antiretroviral therapy (ART) to keep the VL at undetectable levels has given birth to the concept of undetectable equals untransmissible (U = U). This U = U concept is supported by strong scientific evidence which is showing that consistent undetectable VLs for at least six months may prevent an individual from transmitting HIV sexually [8,9,10]
Summary
Since the discovery of the HIV, the search for effective treatment and cure has occupied the scientific community. The sustained ability of ART to keep the VL at undetectable levels has given birth to the concept of undetectable equals untransmissible (U = U) This U = U concept is supported by strong scientific evidence which is showing that consistent undetectable VLs for at least six months may prevent an individual from transmitting HIV sexually [8,9,10]. Given this strong scientific evidence, there have been massive campaigns to promote strict adherence to “test and treat” regardless of CD4 count [13,14] Following all this evidence, the director of the National Institute of Allergy and Infectious Disease (NIAID), Dr Anthony S.
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