Medication Adherence: The Achille’s Heel of U=U

One of the highlights of 2018 that I wrote about last year was the additional research that enforced the important principle that HIV-infected individuals do not infect other individuals when they are suppressed on medication. The rallying cry is “U=U”, that is “Undetectable equals Untransmissible”. If a person is suppressed on HIV medicine, that means the virus is not detectable in their blood (undetectable). A person who is undetectable does not transmit or spread HIV infection to another person. This is fantastic news and therefore, based on this principle, we can control the epidemic and prevent new infections! So, then why hasn’t this happened? All we have to do is make sure everyone who is infected is suppressed and undetectable. So here’s the reality.

1. Everyone who is infected is not receiving treatment. Some people who have been diagnosed with HIV infection are not on treatment for one reason or another. Other people do not even know they are infected, and hence, are not on therapy. In the United States, it is estimated that out of all the individuals who are infected, approximately 1.1 million (in 2015), about 15% of these individuals are not aware they are infected. In addition to not getting the treatment to benefit their own health, they are able to infect other people. GET TESTED!

2. People who are prescribed treatment are not taking it properly. By not taking their medicines as prescribed, they do not have sufficient levels of medicine in their bloodstream to control HIV. There is virus replicating in their blood and tissues and they could pass the virus to someone else through unprotected sex, sharing needles for drug use, or having a baby.

So here’s some more good news. There are programs around the world that make HIV treatment available to people who have no resources to provide for their own medical care. Programs like PEPFAR (President’s Emergency Plan For AIDS Relief), established by President George W. Bush, provide medicines and health for HIV patients in developing countries in Africa, South/South-East Asia.

Here in the US, every state has an AIDS Drug Assistance Program (ADAP) which provides