An apparently substantial minority of gay and bisexual men living with HIV don’t accurately know whether they have an undetectable viral load, aidsmap reports.

In a recent study of a largely white and college-educated group of HIV-positive gay and bi men recruited in various U.S. cities for an intervention to improve their adherence to antiretroviral (ARV) treatment, one in five incorrectly thought they had a fully suppressed viral load.

However, because this study did not draw a representative sample of HIV-positive gay and bi men, it is not necessarily the case that such a high proportion of men in this demographic have a detectable viral load while mistakenly believing their virus to be fully suppressed.

People with HIV who take ARVs and maintain an undetectable viral load cannot transmit the virus. Adhering to the daily drug regimen is key to keeping the immune system healthy as well as sustaining viral suppression, thus eliminating the risk of transmitting the virus.

Publishing their findings in the Journal of Acquired Immune Deficiency Syndromes, Rob Stephenson, PhD, of the University of Michigan, and colleagues conducted a study of 157 HIV-positive men who had been enrolled in a randomized clinical trial of an intervention intended to improve their adherence to ARV treatment and their consistent engagement with medical care.

All the men, who were recruited in Atlanta, Boston and Chicago identified as gay or bisexual and had a steady HIV-negative male partner.

The men were 36 years old on average. Two thirds were white, and 77% were college educated. Ninety-three percent had attended an HIV clinic medical appointment within the previous 12 months, and 99% were taking ARVs, but 48% reported less than 100% adherence to their HIV treatment regimen during the previous months.

The study authors asked the HIV-positive men whether their current viral load was undetectabale or detectable; if they said that it was detectable, they were asked for their viral load level. The researchers then tested the men’s actual viral load with a blood test.

A total of 72.5% of the men accurately reported their current viral load. Another 7.5% said they had a detectable viral load but actually had full viral suppression. Twenty percent stated that they had a fully suppressed viral load but in fact had a detectable viral load.

It is possible that the men’s inaccurate perception of their undetectable status was driven by the fact that they were relying on the results of their most recent test and had adhered poorly to their HIV treatment since then.

The study authors could find no association between the accuracy of viral load reporting and the men’s demographics, sexual behavior, relationship status or adherence to ARVs.

“These results highlight the need to provide interventions to [men who have sex with men] living with HIV to support access to care and ensure current knowledge of viral load and to continue to support primary prevention of HIV through condom use and pre-exposure prophylaxis (PrEP),” the study authors concluded.

Referring to couples in which one partner has HIV and the other doesn’t and to the fact that undetectable = untransmittable (U=U), they continued: “For couples, particularly serodiscordant male couples, interventions that can teach the couple how to collaborate to achieve and maintain viral suppression for the positive partner are an urgent and pragmatic programmatic priority that can equip couples with the knowledge required to correctly implement U=U strategies.”

To read the aidsmap article, click here.

To read the study abstract, click here.