Division of Human Genetics, Department of Pathology & Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa.
School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana.
Int J Environ Res Public Health. 2020 Aug 25;17(17):6163. doi: 10.3390/ijerph17176163.
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.
在过去的十年中，可靠的科学证据已经出现，支持了无法检测到的病毒载量可预防人类免疫缺陷病毒（HIV）这一概念。无法检测到等于无法传播（U=U），这是一个每个人都能理解的简单信息。这一概念的成功取决于对抗逆转录病毒疗法（ART）的严格遵守和实现抑制病毒载量（VL）。要在撒哈拉以南非洲（SSA）实现 U=U，对 ART 的坚持、持续的低水平病毒血症以及耐药突变体的出现是不容忽视的挑战。在 HIV 治愈方法问世之前，U=U 可以大大减轻该大陆的 HIV 流行病学负担并改变其面貌。从公共卫生的角度来看，U=U 这一概念将减少撒哈拉以南非洲地区 HIV 感染者（PLWHIV）的污名化，并加强公众对 HIV 感染并非死刑的接受程度。这也将促进 ART 的坚持，因为 PLWHIV 将努力在尽可能短的时间内实现 U=U。本文重点介绍了实现 U=U 所面临的挑战和障碍，并提出了如何推广这一概念，使其在 SSA 地区受益和适用。如果政策制定者、临床医生、卫生服务提供者和 HIV 控制项目巧妙地包装这一概念，将有助于遏制 SSA 地区的疫情蔓延。
