How accurate are people’s beliefs about their viral load?

The vast majority of people taking HIV treatment in the UK have an accurate knowledge of their current viral load, according to a new analysis.

In 2011 and 2012, over 2600 people attending HIV clinics in the UK completed a survey. (We’ve reported several other results from this study over the past few years.) One of the questions concerned what the person thought their viral load was – undetectable (below 50 copies/ml), detectable (above 50 copies/ml) or don’t know. Their answers were compared to clinic records.

According to clinic records, most people (2334 people) had an undetectable viral load. Within this group, 88% correctly reported that their viral load was undetectable, 2% incorrectly reported their viral load as detectable, and 9% did not know.

Just 344 people had a detectable viral load. Fifty-three per cent correctly reported their viral load, but 22% (76 people) incorrectly said they were undetectable and 25% did not know.

Of the 2137 people who told researchers that their viral load was undetectable, 96% had a clinic-recorded viral load below 50 copies/ml, with 99% having a viral load below 1000 copies/ml.

The researchers say that the accuracy of people’s beliefs about undetectable viral load can be directly relevant to their HIV-negative sexual partners. “The high level of accuracy of a self-reported undetectable viral load is encouraging, as this implies that decisions to have condomless sex on this basis will generally be well informed,” they comment.

The small number of people who had inaccurate knowledge of their viral load were more likely than other participants to not have enough money for basic needs, not be fluent in English, be very secretive about their HIV status, have problems with adherence, and have symptoms of depression. The researchers say that clinic staff’s efforts to engage and educate their patients should prioritise people such as these who have more complex needs.

For a simple explanation of what undetectable viral load is and why it matters, see NAM’s leaflet ‘Undetectable viral load’.

Smoking and pregnancy

Smoking dramatically increases the risk of miscarriage or stillbirth in pregnant women living with HIV, according to a new study. This American study compared data on HIV-negative and HIV-positive women. It found that among non-smokers, the rates of miscarriages and stillbirths were no different between HIV-negative and HIV-positive women.

But smoking increased the risk of these problems occurring. Moreover, the effect of smoking on miscarriage and stillbirth differed dramatically by HIV status, with HIV-positive women much more likely to have a problem.

The researchers speculate that this may be because HIV and smoking are both associated with inflammation and immune activation, processes associated with poor pregnancy outcomes.

For more information on these topics, see NAM’s interactive tool HIV & Pregnancy, and NAM’s factsheet 'Smoking'.

Two-thirds of European HIV cases in Russia

A recent report from the World Health Organization highlights how the HIV epidemic is changing in Europe. The data come from 2015.

• 64% of all new HIV diagnoses in Europe occurred in Russia. The rate of new diagnoses has been increasing dramatically over the past decade; the Russian government recently admitted that more than one million Russians are living with HIV.

• Across the whole population, 1 in 1500 Russians were diagnosed with HIV in one year. This is nine times greater than the rate elsewhere in Europe – 1 in 13,000 people diagnosed.

• Whereas diagnoses of AIDS-related conditions are now extremely rare in western Europe, they continue to be a frequent problem for Russians living with HIV.

• The number of new diagnoses in western European countries has not been increasing in recent years. The epidemic in these countries is increasingly concentrated in gay men, with fewer infections in heterosexual men and women, or in people who inject drugs.

• In Georgia, Belarus, Ukraine and other countries, the numbers of diagnoses in gay men are small, but have increased dramatically in recent years. It’s unclear whether this is an emerging problem or whether more men being diagnosed with HIV are prepared to admit they caught HIV from other men.

• Over a quarter of all new diagnoses are made in people born outside the country they are living in. Many are people born in Africa and other high-prevalence countries, but an increasing number are people born in another European country.