Roger-Luc Chayer (Image : AI / Gay Globe)
A French Influencer Questions the I=I Principle and HIV Undetectability
A French influencer posted on his Instagram account last week, claiming that one should not rely on HIV undetectability in the blood as a guarantee of untransmissibility, thus challenging the principle I=I (Undetectable = Untransmittable).
Understanding the I=I Principle
I = I means “Undetectable = Untransmittable.” It is a public health message related to HIV (human immunodeficiency virus). It indicates that a person living with HIV, who follows their treatment correctly and whose viral load is undetectable, does not transmit the virus sexually.
Specifically, when a person takes their antiretroviral treatment correctly and their viral load remains undetectable for at least six months, the virus is controlled to the point that it cannot be transmitted during sexual activity, even without a condom. This statement is based on major international scientific studies, such as PARTNER and HPTN 052, which observed no transmission under these conditions.
The I=I message is now recognized by major public health organizations, including the WHO and UNAIDS. It has transformed understanding of HIV, reduced stigma, and empowered people living with the virus.
Undetectable Does Not Mean Cured
This does not mean that HIV is cured. The person remains HIV-positive and must continue treatment. If treatment is interrupted, the viral load can become detectable again.
The Influencer’s Doubts About Undetectability
According to the influencer, HIV-positive individuals, even on regular treatment and with an undetectable viral load, may not remain so permanently. The individual, who is not a doctor but a patient, claims that under certain conditions, even with regular treatment, the viral load could increase and make the person transmissible again, without them being aware. This is a claim that deserves clarification.
Viral Load and Effective Treatment
In a person living with human immunodeficiency virus on effective treatment, the viral load remains controlled. If they take their medication correctly, the virus does not suddenly begin replicating significantly within hours or days.
However, there are important nuances. If treatment is interrupted or taken irregularly, the viral load can rise within weeks. In this case, the person could become transmissible, sometimes before their next follow-up test. This is why treatment adherence and regular viral load testing are essential.
Viral Blip: Definition and Consequences
In the case of a simple “viral blip” (a small, temporary, isolated increase), scientific data generally show that it does not challenge the I=I principle, as long as the viral load remains broadly suppressed.
A viral blip can occur during an intercurrent infection, such as a cold or COVID-19, but current scientific evidence shows that this does not make the person transmissible if they are on effective treatment and usually undetectable.
In a person living with human immunodeficiency virus, a cold or infection like COVID-19 can temporarily stimulate the immune system. This activation can cause a slight, transient rise in viral load, often at very low levels (for example, 50 to 200 copies/ml), followed by a quick return to undetectability without any change in treatment.
Major studies establishing the I=I principle have shown that no sexual transmission was observed when the viral load was maintained below 200 copies/ml. An isolated blip, if transient, does not appear sufficient to cause transmission.
What would be concerning is not a small, temporary blip due to a mild infection, but a persistent elevation of viral load across multiple consecutive tests, which could indicate an adherence issue or drug resistance.
How to Manage a Viral Blip
Managing a viral blip begins with staying calm. In a person living with human immunodeficiency virus on effective antiretroviral treatment, a blip generally represents a small, transient rise in viral load, followed by a spontaneous return to undetectability.
The first step is to confirm the result. Doctors typically recommend repeating a viral load test a few weeks later. Very often, the result returns to undetectable without any treatment modification. A single slightly detectable measurement (for example, 50 to 200 copies/ml) is not considered treatment failure.
It is also important to check treatment adherence. Even minor lapses (repeated delays, occasional missed doses) can cause a temporary rise. Returning to a strict, consistent regimen often stabilizes the situation.
The healthcare provider can also explore temporary factors such as a recent infection (cold, flu, COVID), a vaccination, significant stress, or certain drug interactions. These factors can stimulate the immune system and cause temporary fluctuation.
What changes clinical management is not an isolated blip, but a viral load that remains detectable across multiple consecutive tests, especially above 200 copies/ml. In this case, the doctor may request additional tests, including a resistance test, to adjust treatment if needed.
In the vast majority of cases, an isolated viral blip does not compromise the person’s health or the I=I principle, as long as viral suppression is maintained over time.
Caution and New Infections
However, as caution is the mother of safety, it may be wise to recommend that in the presence of a new infection, even if treatment continues uninterrupted, partners take precautions again during sexual activity, assuming that the HIV viral load could temporarily rise, and the person could become, at least in theory, temporarily transmissible.
From a scientific standpoint, current data regarding human immunodeficiency virus do not support the idea that a mild infection alone, in the context of strict treatment adherence, makes a person suddenly and permanently transmissible. An isolated viral blip is not considered a return to sexual transmission risk, as long as viral suppression remains broadly maintained.
ADVERTISING
