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A recent review reported an almost zero transmission risk for VL\u2009&lt;\u20091000 copies\/mL but lacked quantitative risk estimates. This systematic review aimed to quantify transmission risk across VL levels. A literature search (November 2023, updated January 2025) identified 152 studies, with 9 included in the analysis. Seven possible transmissions occurred when the PLHIV had a VL of\u2009&lt;\u20091000 copies\/mL at the last measurement before the estimated time of transmission. However, VL at the exact time of transmission was unknown and VL\u2009&gt;\u20091000 copies\/mL cannot be excluded. This review suggests sexual transmission is very rare with recent VL\u2009&lt;\u20091000 copies\/mL however, future research is required to establish precise risk estimates.<\/jats:p>\n                  <jats:p>PROSPERO Number: CRD42023476946.<\/jats:p>","DOI":"10.1007\/s10461-025-04976-5","type":"journal-article","created":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T10:44:06Z","timestamp":1765968246000},"page":"1538-1553","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Association Between Different Levels of Suppressed Viral Load and the Risk of Sexual Transmission of HIV Among Serodiscordant Couples on Antiretroviral Therapy: A Systematic Review"],"prefix":"10.1007","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9708-6530","authenticated-orcid":false,"given":"Pascal","family":"Djiadeu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1561-9423","authenticated-orcid":false,"given":"Housne","family":"Begum","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8378-9082","authenticated-orcid":false,"given":"Michelle","family":"Haavaldsrud","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2173-488X","authenticated-orcid":false,"given":"Giovanna","family":"Busa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6022-4455","authenticated-orcid":false,"given":"Jeffery","family":"Dansoh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0462-4040","authenticated-orcid":false,"given":"Phu","family":"Van Nguyen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0914-0056","authenticated-orcid":false,"given":"Taline","family":"Ekmekjian","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6185-7227","authenticated-orcid":false,"given":"Annie","family":"Fleurant","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4703-7131","authenticated-orcid":false,"given":"Stephan","family":"Gadient","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9460-980X","authenticated-orcid":false,"given":"Chris","family":"Archibald","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,12,17]]},"reference":[{"key":"4976_CR1","unstructured":"Joint United Nations Programme on HIV\/AIDS. 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