When HIV broke out in the 1980s, thousands of people had only a few weeks or months from diagnosis to death. But that is if they even managed to be diagnosed before they died, according to the World Health Organisation. Although currently commendable developments to deal with HIV are in place, it remains an epidemic without cure or vaccination. In 2018, more than 70 million people had acquired the infection since it began, and half of them have died. In that year, 37 million people worldwide lived with HIV, of whom 22 million were on treatment. Among the new developments is the treatment for HIV, antiretroviral therapy (ART). Taking this medicine has proven to help HIV patients live healthier and much longer than when not taken. Countries all over the world including Rwanda have expanded its access, leading to commendable results. For Rwanda, in 2018, 83 per cent of adults living with HIV were aware of their status, of whom 97 per cent were on ART. 90 per cent of those on ART had viral load suppression, which means their immunity was higher and they had low chances of spreading the virus. But what is viral load suppression and why should we still protect from HIV if we can still live healthy and long? The New Times’ Glory Iribagiza had a conversation with Dr Simeon Tuyishime, the Director of HIV Care and Treatment at Rwanda Biomedical Centre (RBC) on the topic. What is viral load suppression and why is it important? Viral load suppression is when the amount of HIV in the body is reduced to a low level. This keeps the immune system working and prevents illness. In Rwanda, our standard measurement is when an HIV positive person has less than 200 copies of HIV per millilitre of blood. It is important because it is the main goal of HIV treatment (Antiretrovirals; ARVs). When the HIV quantity of viral copies reduces in the body, there is a high chance that the person living with HIV will not have opportunistic infections. Keeping HIV at this low level helps the person living with HIV stay healthy and live longer, and greatly reduces the risks transmitting HIV to others. Can someone be virally suppressed to the extent of being tested HIV negative? I can’t say that someone who has previously tested positive for HIV can test negative again, because currently, HIV can’t be cured. But someone can have very few copies of the virus present in their blood that todays monitoring tests are unable to detect. A participant wears a T-shirt with a message urging people to test for HIV during an event to mark the World AIDS Day. Photo: File. In Rwanda, to be undetectable, one needs to have fewer than 20 viral copies per millilitre of blood because our viral testing machines can now detect and quantify HIV copies at that level. Can an undetectable viral load person transmit HIV to others? The risks of transmitting HIV to others tremendously reduces. Different researches have been conducted where undetectable people didn’t transmit the virus. However, since there are incidents where people stop medication temporarily, or the fact that no one tests every day, it is better for people to be careful and still use available HIV preventive measures. Also, not much research has been done on pregnant women and breastfeeding mothers. We still encourage people to protect themselves. What is the difference between PrEP and PEP? PrEP stands for pre-exposure prophylaxis. It is a medication taken proactively to prevent HIV by people believed to be exposed to HIV regularly. They could be sex workers, people whose sexual partners are infected with HIV, not on treatment or not virally suppressing, and males who have sex with males (MSM). Having PrEP doesn’t mean that other methods of protections are omitted. We still encourage people to use them as well. PEP on the other hand, stands for post-exposure prophylaxis. It is medication taken to prevent HIV after a person thinks they may have been exposed to the virus, and within 72 hours. Can an undetectable viral load woman transmit HIV to an unborn child? Available research does not talk about pregnant women and their children. But when a pregnant woman takes her medication well and is undetectable, the chances to not infect her child are very high. This is because the amount of copies of HIV in the body fluids determine its spread. The lower the copies of the virus, the lower the transmission rate. If a woman is HIV positive, she must take her medication properly to reduce the risk of infecting her child. But this has to go hand in hand with taking good care of herself, like through proper feeding. Given all the developments, do we still need to protect from HIV? Although new developments help people living with HIV to live a good life, it is still better to not be infected. Prevention has always been better than cure. Cure comes with a cost that one wouldn’t have incurred, to begin with. Even resources invested in providing treatment and care of people living with HIV could help with other utilisation instead. And let us not forget that there could be instances where one may not be able to take medication while living with HIV and that person may have illness because of immune deficiency.
