Science concept that is curbing spread of HIV

Did you know that your sexual partner living with HIV may not transmit HIV to you through sex? The scientific concept known as Undetectable=Untransmittable (U=U) has proved that people with suppressed viral load do not transmit HIV through sex.

Dr Lazarus Momanyi, from National AIDS and STI Control Programme (NASCOP) says that the U=U statement targets to diminish the stigma associated with having HIV while at the same time reducing barriers to HIV testing and treatment.

Scientists also hope that U=U will improve self-esteem by removing the fear of being contagious, support healthy sexuality regardless of HIV status, reduce sex partner’s concerns and also increase interest in starting and staying on HIV treatment known as antiretroviral therapy (ART).

“This is the global destination that if you have a durable viral load that is below 200 copies/ml then you do not transmit HIV through sex to your sexual partner,” said Dr Momanyi during the Fifth African Conference of Science journalists held virtually on Tuesday.

Dr Momanyi, however, warned that U=U does not protect an individual from sexually transmitted infections and pregnancies. In this regard, he said that even after achieving the U=U, individuals should continue using combination prevention strategies like a condom.

Last year in September, Kenya launched the U=U campaign which has been associated with improved health outcomes among people living with HIV as well as minimizing missed opportunities.

Scientific evidence

U=U is supported by scientific evidence in a study known as HPTN 052 which was enrolled on 1,763 HIV serodiscordant couples, where one person is HIV-infected and the other is not at 13 sites in nine countries. The majority of the couples were heterosexual (97%).

During the study, HIV-infected partners were assigned to start ART at the beginning of the study, called the “early” arm (CD4 count at ART initiation 350-550 cells/mm3), or later in the study, called the “delayed” arm (CD4 count at ART initiation 350-550 cells/mm3). Those on the delayed arm started ART when their bodies’ immune systems were declining.

Most leading HIV scientists and health care workers now agree with the U=U statement. This includes the British HIV Association (BHIVA), the International AIDS Society (IAS), UNAIDS, and the Centre for Disease Control (CDC). More than 900 organizations have joined from over 90 countries.

Scientists have termed interim results of the HPTN 052 study a landmark study proving that early ART can prevent HIV transmission. As a result of the study, World Health Organization, in 2013, recommended that antiretroviral treatment be offered to all people living with HIV who have uninfected partners to reduce HIV transmission.

Myths and misinformation

The journey to HIV treatment has taken decades creating room for myths and misinformation spread by even scientists. In 1996 a renowned Kenyan scientist and pharmacologist at the University of Nairobi Prof. Arthur Obel made a series of wrong drugs which he claimed converted the positive serostatus of 7 HIV patients. In 2000 former president of South Africa, Thabo Mbeki during the IAS conference in Durban, rejected science and declared AIDS the collapse of the immune system but not because of a virus and ARVs should be taken action.

Former president of Gambia, Yaya Jammeh in 2007 declared to the world that he could cure HIV/AIDS with a herbal concoction. Then came the self-proclaimed Ambilikile Mwasapile alias Babu wa Loliondo in 2010 who claimed that God in a dream gave him the recipe of herbal medicine that could heal all maladies including HIV/AIDS if the patients drank a cup of his concoction.

Prophet from Mzuzu, Northern Malawi, Shepherd Bushiri also claims to have cured people of HIV, changed the fortunes of the impoverished and walked on air.

Treatment and cure

However, there seems to be light at the end of the tunnel following the documented two cases of people who have been healed from HIV/AIDS. The two are Timothy Ray Brown alias “the Berlin Patient” who was diagnosed with Acute Myeloid Leukemia in 2006, after living with the virus for 11 years on ARVs. Chemotherapy failed, received the first of two bone marrow transplants. Researchers later only found traces of the viral genetic material, none of which can replicate and hence declared cured. He died in 2020 of cancer.

The second case is a middle-aged woman of mixed-race ancestry who had developed acute myeloid leukemia while on ART, 4 years after HIV diagnosis. In 2017, she received a transplant of umbilical cord blood stem cells. Three years post-transplant, the patient stopped ART. No HIV was detected in the patient for 14 months except for a short transient detection of trace levels of HIV DNA in the patient’s blood cells at 14 weeks after stopping ART. Her case was reported at a conference for Retroviruses and Opportunistic Infections 22 (CRO1 22).

Scientists are going on with vaccinations and treatment research for HIV positive individuals. In the meantime, effective suppression of the virus, and boosting the immune system is the only available treatment even as interventions to permanently suppress or eradicate HIV continue.