Progress on the 'Third 90' target is not a reliable guide to HIV transmission potential, South African study shows
Aidsmap - "Measuring the proportion of people with an undetectable viral load may be lulling health policymakers into a false sense of security in their efforts to control HIV transmission through comprehensive treatment, according to a new study from South Africa.
Undetectable viral load has been adopted “as a proxy for ART [antiretroviral therapy] program effectiveness” as a result of the UNAIDS 90-90-90 target, which aims for 90% of people living with HIV diagnosed, 90% of people with diagnosed HIV infection to be on treatment and 90% of people on treatment to have undetectable viral load by 2020. The undetectable viral load target is often referred to as the 'Third 90'. Progress towards this target leads to the assumption that the number of people with HIV who have a detectable viral load, and who might pass on HIV, is shrinking.
But, say researchers from the Africa Health Research Institute, Durban, in settings with very high HIV prevalence, focusing on the proportion of people with HIV who still have detectable viral load gives a false sense of how much potential for HIV transmission exists in the population. Instead, health policymakers need to focus on the proportion of the entire population that has detectable viral load, so as to take into account the growth of the population living with HIV over time.
Research by the same group due to be published shortly has shown that the risk of acquiring HIV is strongly associated with the proportion of the entire population that has detectable viral load, but not the proportion of people with HIV with a detectable viral load. [...]
The investigators warn that although measuring the proportion of people with HIV with detectable viral load “may reflect a community’s exposure to ART, it may not tell us enough about the potential for HIV transmission within the general population.” They warn that countries should monitor and report the prevalence of detectable viremia among all adults as a more reliable proxy for HIV transmission risk." (Photo: World Bank/flickr, CC BY-NC-ND 2.0).