Editor's Note: In recent years, the concept of “U=U” (Undetectable equals Untransmittable) has become widely recognized in the field of HIV prevention. This concept is based on extensive scientific research showing that HIV patients on effective antiretroviral therapy (ART) who achieve and maintain an undetectable viral load (typically defined as less than 20 or 50 copies/mL) have a negligible risk of sexually transmitting the virus. The introduction of “U=U” has not only changed our understanding of HIV transmission but also provided significant confidence and support to HIV patients and their partners, encouraging more individuals to engage in treatment to achieve personal health and public health goals. At the 25th International AIDS Conference (AIDS 2024), a recent study revealed that over 95% of HIV patients in Australia on ART achieved sustained viral suppression (SVS) over the past three years, which holds significant implications for global HIV management and prevention strategies in the “U=U” era.In Australia, the viral suppression rate among HIV patients has consistently been high. However, previous data primarily reflected viral load (VL) test results from single reporting periods, failing to comprehensively capture sustained suppression. This study aimed to assess the level of SVS (defined as all VL tests <1000 copies/mL in the past three years) among HIV patients in Australia and explore factors influencing consistent viral suppression.
The study utilized data from the Australian National Monitoring System, ACCESS, including 6,444 HIV patients who attended 60 healthcare services within the ACCESS network in 2022. These patients were predominantly male (95%), over 16 years old, consistently receiving ART, and had undergone at least two VL tests in the past three years.
Results showed that 95.5% (6,090 patients) achieved SVS over the past three years, while 98.4% achieved viral suppression based on their most recent VL test. Multivariate regression analysis indicated that patients residing in inland/remote areas, those under 30 years of age, those receiving treatment at publicly funded sexual health clinics or hospitals, and those diagnosed with gonorrhea, HCV co-infection, or previous HBV infection in the past three years were less likely to achieve SVS. Conversely, patients from culturally and linguistically diverse backgrounds and those with higher initial CD4 counts were more likely to achieve SVS.
The study underscores the importance of SVS for the overall health of HIV patients and reducing transmission risk. Dr. Jason Asselin, the spokesperson for the research project, stated, “Although the viral suppression rate among HIV patients in Australia is already high, we still need to focus on patients in disadvantaged conditions to ensure they receive the necessary support and resources to achieve and maintain viral suppression.”
Dr. Asselin recommends targeted support measures for younger patients, those who might engage in unprotected sex or share injection equipment, those living in non-metropolitan areas, and those treated at publicly funded health services to improve ART adherence and SVS rates. These efforts will help further reduce HIV transmission and enhance the quality of life for HIV patients.
Note: This study was conducted in collaboration with the Kirby Institute at the University of New South Wales, Melbourne Sexual Health Centre, Central Clinical School at Monash University, Centre for Epidemiology and Biostatistics at the University of Melbourne, Victoria Health Protection Agency, Cairns Sexual Health Service, Sydney Sexual Health Centre, and the Australian Federation of AIDS Organisations.
