How Is This Possible
The likelihood of passing on HIV is directly linked to the amount of the virus in your blood. The lower the amount of virus in your blood, the lower the chance of it being passed on and vice versa.
When taken correctly, HIV treatment reduces the amount of virus in someones blood. When the virus is reduced to extremely low levels to the point where a laboratory test cannot pick it up, the virus cannot be passed on. This low level of virus in the blood is what is called an undetectable viral load. Different laboratories may have different cut-off points when classifying an undetectable viral load however, most clinics in the UK classify undetectable as being below 20 copies of HIV virus per millilitre.
It is important to note that a key goal of treatment is to ideally get everyone living with HIV to have an undetectable viral load. While an undetectable viral load does not mean there is no HIV present, it helps people with HIV to live long and healthy lives.
The Bottom Line: Bringing Hope To People Living With Hiv
Increasing awareness that having an undetectable viral load means that people living with HIV who remain on medications will not transmit the virus can have a dramatic impact on public and personal views of HIV. We have the tools to end the epidemic, keep people living with HIV healthy and unable to transmit the virus , and keep HIV-negative people negative through PrEP and post-exposure prophylaxis .
The epidemic continues because people are living with HIV without knowing it, because they have never been tested. HIV stigma is the biggest barrier to ending the HIV epidemic, so it is important to break down that stigma wherever possible by providing access to information, community support, and advocacy all of which build hope.
U=U has the potential to address all kinds of HIV stigma including institutional stigma occurring in healthcare settings, workplaces, and broadly across society interpersonal stigma that can be so damaging among family and friends and internalized stigma , which many people don’t even realize they have.
While researchers must continue to examine the promise and impact of treatment as prevention, the science that is currently available strongly supports U=U. That alone is a reason to make sure that all people living with HIV, or vulnerable to acquiring HIV, have access to this information so that they can make the most informed decisions possible about their own sexual health and lives.
How Do I Explain This To A Sexual Partner
If you have sexual partners who are not living with HIV, explaining U=U to them is likely to be mutually beneficial. If you had previously relied on other means of preventing HIV transmission , you may jointly decide that these methods are no longer necessary because of U=U.
It may take some time for an HIV-negative partner to accept the U=U message and to rely on it as the sole method of preventing HIV. Some HIV-negative people may reject the message or deny its accuracy. It may be helpful to direct your partner to information resources that explain the accuracy and significance of U=U. NAM has also produced a page for people who dont have HIV to help them understand the impact of an undetectable viral load on HIV transmission.
Another option could be for your partner to hear about U=U from a healthcare worker or another reliable and trusted source.
Despite sharing this information, some people may still not accept that U=U. In this kind of situation, it is important to find a balance between providing your partners with information and taking care of yourself.
Many people find it difficult to talk about sex, even with the person who is closest to them. If this is the case, you might want to discuss your concerns with someone at your HIV clinic, sexual health clinic or a support organisation. This can help you clarify your thoughts and what youd like to say.
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How The Study Worked
The study focused on HIVpositive French men who requested sperm washing from 2002 through 2011. All men were heterosexual and had a stable relationship with a female partner. All men were taking combination antiretroviral therapy.
The researchers measured virus in paired blood and semen samples from each man. The tests used to measure HIV could detect as few as 40 copies of HIV RNA per milliliter of blood and 100 copies per milliliter of semen.
In one third of the men, the researchers also used more sensitive tests to measure HIV RNA in blood and HIV DNA in blood cells. HIV DNA is the form HIV takes when resting inside cells that it infects. These sensitive tests could detect 1 copy of HIV RNA per milliliter of blood and 5 copies of HIV DNA per 150,000 blood cells.
Dont Breastfeed Your Baby
- Do not breastfeed your baby, even if you have an undetectable viral load. Having an undetectable viral load reduces the risk of transmitting HIV to the baby through breastfeeding but doesnt eliminate the risk.
- The current recommendation in the United States is that mothers with HIV should not breastfeed their babies.
You should also have a pelvic examination and get tested for other sexually transmitted diseases during your pregnancy.
If I have an undetectable viral load, do my partner and I need to use anything else to prevent sexual transmission of HIV?
Getting and keeping an undetectable viral load prevents HIV transmission during sex. But there are situations when either partner may want to use additional prevention options.
- Using condoms can help prevent some other STDs.
- Using condoms or having your partner take PrEP can provide added peace of mind.
- Also consider using additional prevention options if you
- Are unsure, for any reason, that you have an undetectable viral load
- Have a high viral load
- Have trouble taking HIV medicine regularly
- Missed some doses since your last viral load test or
- Have stopped taking HIV medicine or may do so in the future.
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How Do I Talk To My Partner About Their Risk Of Acquiring Hiv
People living with HIV can involve their partners in their treatment plans. Research shows that adhering to treatment often can improve with support from loving relationships and from the community.
Pre-exposure prophylaxis , in which an HIV-negative person takes antiretroviral medication to prevent infection, can be part of the conversation. Learn more about PrEP.
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What If I Miss One Dose Will My Viral Load Become Detectable Again
If you are undetectable, and have been taking your medications every day recently, your viral load will very likely stay undetectable even if you miss one dose. The HIV medications are so good these days that it can take a week or even sometimes up to several weeks or more for peoples viral loads to become detectable after medications are stopped.
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How Is Hiv Transmitted From Mother To Child During Pregnancy
If you are a pregnant woman living with HIV there are a number of ways that HIV might be passed on to your baby. HIV in your blood could pass into your babys body. This is most likely to happen in the last few weeks of pregnancy, during labour, or delivery. Breastfeeding your baby can also transmit HIV, because HIV is in your breastmilk.
There is a 15 to 45% chance of passing HIV on to your baby if neither of you take HIV treatment.
However, taking the correct treatment during your pregnancy and while you breastfeed can virtually eliminate this risk.
Hiv And Your Sexual Health
If you do not know your HIV status, get tested. HIV tests are fast and easy, and they are also free at NYC Sexual Health Clinics. A positive test is an opportunity to treat HIV, stay healthy and prevent HIV transmission. A negative test gives you the chance to discuss ways to stay negative, such as using condoms or taking daily pre-exposure prophylaxis .
If you do not have HIV, PrEP can help you avoid it. PrEP is a safe and effective daily pill that prevents HIV.
If you have HIV that is undetectable, you cannot pass it through sex, even if you do not use condoms. Condoms can still help protect against other sexually transmitted infections and unplanned pregnancy.
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Ecdc Comment: Prevention Benefits Of Viral Suppression
The encouraging PARTNER2 study results give further impulse on the way towards the global target of ending AIDS by 2030. They can particularly address and help reduce HIV-related stigma, both among HIV-positive people as well as the public, by reinforcing the message: people living with HIV who are on effective ART do not pass on the virus.
In fact, achieving and maintaining an undetectable viral load serves as a very effective prevention method to help interrupt existing transmission chains. This applies for gay men as well as heterosexual couples.
However, reaching and maintaining an undetectable viral load is just one step in the socalled HIV continuum of care. Effective HIV treatment depends on being diagnosed and starting treatment early and adhering to it closely at a time when an estimated 11-17% of people living with HIV in the European Union and European Economic area are not even aware of their infection and thus not receiving treatment and care. Retention in care is essential to improve adherence and to monitor the health of people who are on HIV treatment correctly.
The consistent use of condoms remains necessary to prevent the transmission of other sexually transmitted infections as these are not prevented by HIV treatment or by using HIV pre-exposure prophylaxis .
What Are Viral Load Blips
Even if a person is durably undetectable and taking antiretroviral therapy daily as prescribed, they may experience small, transient increases in viral load called blips followed by a decrease back to undetectable levels. Having a blip is relatively common and does not indicate that antiretroviral therapy has failed to control the virus. Scientists are working to better understand what causes blips.
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How Do Antiretroviral Treatments Work
Antiretroviral Treatments, or ARTs, stop the virus from reproducing and that means your immune system can repair itself and isnt damaged further, then it can cope. It is proven that you cannot pass the virus on and that you can live an active and healthy life and have a normal life expectancy. You can also have sex and conceive children without passing the virus on. How fantastic is that!
Does Being Durably Undetectable Mean That The Virus Has Left My Body
Even when viral load is undetectable, HIV is still present in the body. The virus lies dormant inside a small number of cells in the body called viral reservoirs. When therapy is halted by missing doses, taking a treatment holiday or stopping treatment, the virus emerges and begins to multiply, becoming detectable in the blood again. This newly reproducing virus is infectious. It is essential to take every pill every day as directed to achieve and maintain a durably undetectable status.
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Testing Positive On Hiv Antibody Tests
Since the early days of the HIV epidemic, we have used antibody tests to test for HIV. Antibody tests are the most affordable and accessible HIV tests. They are the most common types of HIV tests at testing sites around the world because they provide rapid, on-the-spot results.
Antibody tests do not detect HIV. Instead, they detect antibodies that the immune system produces in response to HIV infection.
WHAT ARE ANTIBODIES?
Our immune systems develop antibodies in response to all kinds of pathogens. Anytime you get sick or get any kind of infection, your body builds up a defense system and creates antibodies to try and fight that specific infection off. If these antibodies are successful, some infections will go away but the antibodies never do. They will remain in your body, helping to protect you from getting the same infection in the future.
In this way, antibodies allow our bodies to remember a specific infectious agentlike a particular strain of the fluand then respond to it more quickly if exposed to it again in the future. Once we develop antibodies to a virus we may have those antibodies for life or for many years.
HIV ANTIBODIES WHEN YOURE UNDETECTABLE
Symptoms Of Hiv Infection
Most people experience a short flu-like illness 2 to 6 weeks after HIV infection, which lasts for a week or 2.
After these symptoms disappear, HIV may not cause any symptoms for many years, although the virus continues to damage your immune system.
This means many people with HIV do not know they’re infected.
Anyone who thinks they could have HIV should get tested.
Some people are advised to have regular tests as they’re at particularly high risk.
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Viral Load At Different Stages
During the first few weeks after someone gets HIV, viral load is usually very high typically several million viral copies per millilitre of blood . There is a considerable risk of passing on HIV at this point. In fact, many people acquire HIV from someone who has only recently acquired it themselves .
After this period of early infection, viral load usually drops. A typical viral load in someone not taking treatment may be 50,000 copies/ml. There is still a considerable risk of passing HIV on.
After starting HIV treatment, viral load usually falls rapidly. Within three to six months, most peoples viral load has become undetectable.
Most clinics in the UK report a viral load as undetectable if it is below 20-50 copies/ml. However, if your viral load remains below 200 copies/ml , there is no risk of passing HIV to your sexual partners. There is no need to worry if your viral load goes slightly above the detection limit of 20-50 copies/ml.
When viral load is detectable, this indicates that HIV is replicating in the body. If the person is taking HIV treatment but their viral load is detectable, the treatment is not working properly. There may still be a risk of HIV transmission to sexual partners.
How Is Pep Different From Prep
PrEP and PEP are both forms of HIV prevention for people who are HIV-negative. A big difference between PrEP and PEP is that PrEP is taken before potential exposure, while PEP is taken after possible exposure to HIV. While PEPis prescribed in emergency situations and should be taken within 36 hours of exposure, PrEP is a daily pill that people can take to protect themselves against HIV if they think they will be sexually exposed.
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U=u Frequently Asked Questions
In September 2017, the New York State Department of Health became the first state health department in the Unites States to sign on to the Prevention Access Campaigns Undetectable equals Untransmittable Consensus Statement. In doing so, the Health Department endorsed the following statement:
“People living with HIV on ART with an undetectable viral load in their blood have a negligible risk of sexual transmission of HIV. Depending on the drugs employed it may take as long as six months for the viral load to become undetectable. Continued and reliable HIV suppression requires selection of appropriate agents and excellent adherence to treatment. HIV viral suppression should be monitored to assure both personal health and public health benefits.”
The framework of U=U offers a unique opportunity to dismantle HIV stigma and discrimination, and reemphasizes the critical importance of antiretroviral therapy , daily adherence, and continuous engagement in medical care for people living with HIV.
**NOTE: Definitions are available via mouse hover on italicized words below.
How Do I Know If My Viral Load Is Undetectable
The only way to know if your viral load is undetectable is through an HIV viral load or HIV RNA test that your doctor or health care provider can do. You will need to have your blood drawn for this test, and the test will determine the level of virus in your blood that day. If the level of virus in your blood is below the limit of detection of the test, then we say your virus is undetectable.
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What Is Effective Treatment
We are using the term effective treatment to mean that someone is on treatment, taking it as prescribed and has an undetectable viral load. In the UK this is usually classed as a viral load below 20 copies/ml.
The Partners PrEP study found that there remains a transmission risk within the first six months of treatment as the HIV positive partners viral load takes time to come down.
Therefore effective treatment means someone has been taking it as prescribed for at least six months and has an undetectable viral load.
Over 90% of people diagnosed with HIV in the UK are on effective treatment and undetectable, and therefore are not infectious .
How Variable Is An Undetectable Viral Load Can This Change Over Time
HIV specialists have decades of experience managing antiretroviral therapy and are confident that you can remain uninfectious as long as you:
- take your medication every day as prescribed, and
- have your viral load checked regularly.
The presence of other sexually transmitted infections can potentially affect viral load, but in the PARTNER study there were no HIV transmissions even when other STIs were present. Those results held through the PARTNER 2 trial as well.
It is however important to remember that HIV treatment can only be successful if you have access to it and are taking it as prescribed.
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