U = U

[TabooPrincess]

Could someone explain the U = U stuff to me better than my google searches? So I don’t have to use condoms now, I get that. But how can we know if we are still undetectable between tests? I’ve tested undetectable for 8 years but occasionally I miss doses or take them late etc. I can’t find much to work out how many missed doses would then equate a risk.
Hoping my questioning makes sense

[Jim Allen]

Hiya.

I moved this to prevention as the question relates to TaSP/U=U.

I’ve tested undetectable for 8 years but occasionally I miss doses or take them late etc.

There is a reason you remain UD, firstly taking the meds a few hours early or late isn't an issue, and adherence is measured by taking your meds 95% of the time. So missing a dose once in a blue moon isn't something to stress about either.

So if your HIV has been suppressed to below 200 copies and keep taking your meds, you should maintain that level of suppression.

Although optimal adherence levels in data & studies have been shown to be way broader than the 90-95% goal, I still think it's still wise to aim to take your meds daily to have that safety margin and a habit of taking them whilst striving to reach at least 95%.

So I don’t have to use condoms now, I get that

Well, you will not pass HIV on sexually, that's correct. Condoms could still be used to reduce the risk for other easier acquire STI's and complications that can arise from having other STI's to treat.

Best, Jim

https://www.poz.com/article/newer-hiv-regimens-may-require-less-strict-adherence

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5943894/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4839839/
Adherence to Antiretroviral Therapy and Virologic Failure

Paterson et al suggested that at least 95% adherence to unboosted PIs was required for virologic suppression. This 95% adherence cut-off point, based on what is now obsolete therapy, has been widely used as the level of optimal adherence needed to be met by patients taking newer agents and their combinations.

https://journals.lww.com/jaids/Abstract/2019/11010/Antiretroviral_Adherence_Level_Necessary_for_HIV.3.aspx

Antiretroviral Adherence Level Necessary for HIV Viral Suppression Using Real-World Data

A benchmark of near-perfect adherence (≥95%) to antiretroviral therapy (ART) is often cited as necessary for HIV viral suppression. However, given newer, more effective ART medications, the threshold for viral suppression may be lower. We estimated the minimum ART adherence level necessary to achieve viral suppression.

Results: The adjusted odds of viral suppression did not differ between persons with an adherence level of 80% to <85% or 85% to <90% and those with an adherence level of ≥90%. In addition, the overall estimated adherence level necessary to achieve viral suppression in 90% of viral load tests was 82% and varied by regimen type; integrase inhibitor- and nonnucleoside reverse transcriptase inhibitor-based regimens achieved 90% viral suppression with adherence levels of 75% and 78%, respectively.

[TabooPrincess]

Thanks Jim
I think unless we can fully get our heads around U=U then the rest of the population will definitely struggle.
Appreciate the quick response

[Jim Allen]

You're welcome.

My own experience from explaining it one-to-one and also at events is people with an open mind understand TaSP/U=U very well when it's explained correctly and they can ask questions.

Although, some people will never want or be interested in understanding it.