Detectable Viral Load If You Are Taking Hiv Treatment
If your viral load hasnt fallen to undetectable levels within three to six months of starting HIV treatment, then your doctor will talk to you about your current treatment. They may ask some detailed questions about how and when you take your anti-HIV drugs and whether you have taken any other drugs including prescription, over-the-counter, herbal or recreational drugs at the same time. This is because not taking treatment regularly, or interactions with other drugs, can cause the levels of anti-HIV drugs in your body to be too low to work. You may have a blood test to look at the level of anti-HIV drugs in your blood and to see if your HIV has developed resistance to any drugs.
Then they will discuss the options with you. This may involve changing your anti-HIV drugs to find a combination that works for you.
Having a detectable viral load when you are taking HIV treatment can mean that your HIV may become resistant not only to the anti-HIV drugs you are taking, but also to other similar anti-HIV drugs as well.
If you are taking HIV treatment and have had an undetectable viral load, and then you have a test that shows a detectable viral load, you will need to have another test to confirm the result. It may just be what is called a viral load blip.
If later tests still show your viral load has become detectable again, you will probably need to change your HIV treatment. Your doctor will discuss your options with you.
How An Hiv Rna Test Is Done
Since the HIV RNA test is a blood test, theres no special way to prepare for it. But some people find that being well hydrated before any type of blood test makes it easier for the technician to find a vein.
A technician will swab your arm with an antiseptic wipe or solution. Then, a blood sample will be drawn from a vein in your arm.
Based upon the lab used, it may take up to 10 days for you to get the results of your test.
Your Viral Load If You Are Not Taking Hiv Treatment
You should have your viral load measured when you are first diagnosed with HIV. If it is known that you have very recently become HIV positive , you will have it measured three to six months later to determine your viral load set point the level of your viral load once it stabilises when the period of primary infection is over.
Your viral load will be checked at least once a year, and more often if you have any symptoms. Your viral load can provide important information about the way that HIV might affect your health if it is left untreated. Among people with the same CD4 cell count, those with a high viral load tend to lose CD4 cells and become ill faster.
Your viral load also provides information about the risk of passing HIV on during sex without a condom. The higher the viral load, the greater the chance of this happening.
If youre not taking HIV treatment, the level of your viral load can fluctuate between tests. Often, increases in your viral load are nothing to worry about. Even a doubling in your viral load might not be significant.
Vaccinations, such as a flu jab, and infections can cause a temporary increase in your viral load. Talk to your doctor about whether you should delay your next viral load test sometimes it is recommended to wait at least one month after having a vaccination or getting over an infection.
Your doctor will probably want to confirm this trend with a repeat test.
Youll have a viral load test just before you start HIV treatment.
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Hiv Rna Tests Vs Hiv Antigen/antibody Tests
A big difference between these types of tests is what the tests are meant to identify.
The HIV RNA test looks for the virus’s genetic material, while the HIV antigen/antibody test looks for both HIV antibodies and the p24 antigen . It may be used as an initial screening test and can detect the virus three weeks after a person has been exposed.
An HIV RNA test is used if a patient has an acute HIV infection and their immune system has not yet had a chance to produce antibodies against the disease. A healthcare provider would decide whether to add an HIV RNA test to the testing plan, regardless of whether HIV antibodies are identified or not.
Why Is Viral Load Important
The viral load is a measure of how active HIV is in your blood. The virus kills white blood cells called CD4 cells, which are an important part of your immune system. When the viral load is high then the CD4 count goes down, the immune system weakens and you are more likely to become sick.
When you start anti-HIV treatment , the viral load test is used to measure how well your treatment is working. One of the goals of ART is to have an undetectable viral load, so the immune system can begin to repair itself. You should have a viral load test every three to six months. The test results are used to monitor how well your HIV treatment is working and whether you may need to change the drugs you are taking.
We now know that even low levels of HIV in the body can cause inflammation which can damage your body. It is recommended that people start treatment as early as possible after they have been diagnosed. This helps reduce the damage that can be caused by HIV-related inflammation.
We also know that people who are engaged in care, taking ART and have an ongoing undetectable viral load are substantially less likely to transmit HIV to others. In fact studies show that people with an undetectable viral load do not pass HIV to their sexual partners.
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When Can I Have Unprotected Sex
If your viral load is undetectable on two occasions 6 months apart, then you can have sex without passing on HIV-1.
Please note being undetectable does not protect you against other STIs.
Page reviewed by Dr. Manoj Malu
Last reviewed date: 21 April 2020Next review due: 21 April 2023
Whilst this content is written and reviewed by sexual health specialists, it is for general guidance only. It is not intended to replace the advice of your clinician.
What Does It Mean If My Viral Load Rises
Many different factors can affect your viral load, such as the progress of HIV infection, your overall health, if you are on treatment whether it is working, and even how the test was performed that day. You and your doctor will try to find the cause of the rise in viral load by looking at your past viral load tests and by searching for other clues.
If you see a rise in your viral load, your doctor may ask you to have another test right away. The second test helps to check whether the rise in viral load is temporary or a consistent trend. Temporary changes in viral load can have many causes. For example:
- Sometimes, your viral load may become detectable on a single test and then go back to undetectable on the next test. This is called a blip and it is normal.
- Your viral load may rise temporarily if you have a cold or other brief illness, or after a vaccination. You might want to wait a month after a vaccination before you have another viral load test.
The way a viral load test is done varies from laboratory to laboratory, and this may change test results. Be aware of this when comparing tests done by two different laboratories, especially if they are in different provinces or countries. If the rise in viral load cannot be explained any other way, it might be a sign that you and your doctor need to look at your treatment plan.
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Is Any Test Preparation Needed To Ensure The Quality Of The Sample
No test preparation is needed.
- to monitor the status of HIV disease,
- to guide recommendations for therapy, and
- to predict the future course of HIV.
Evidence shows that keeping the viral load levels as low as possible for as long as possible decreases the complications of HIV disease and prolongs life.
Initial treatment can take up to 6 months for the viral load to become undetectable, although this is often achieved earlier.There are several methods for testing viral load results are not interchangeable so it is very important that the same method be used each time.
A viral load test is requested, usually in conjunction with a CD count, when a patient is first diagnosed with HIV 1. The test result functions as a baseline measurement that shows how actively the virus is reproducing. Your doctor may request a viral load test and a CD4 count about every four weeks to evaluate whether therapy is being effective. To monitor long-term therapy, your doctor will request viral load tests and CD4 counts about every four months.
Why Do I Need An Hiv Viral Load
Your health care provider may order an HIV viral load when you are first diagnosed with HIV. This initial measurement helps your provider measure how your condition changes over time. You will probably be tested again every three to four months to see if your viral levels have changed since your first test. If you are being treated for HIV, your health care provider may order regular viral load tests to see how well your medicines are working.
You may also need an HIV viral load if you think you may have been recently infected. HIV is mainly spread through sexual contact and blood. You may be at higher risk of infection if you:
- Are a man that has had sex with another man
- Have had sex with an HIV-infected partner
- Have had multiple sex partners
- Have injected drugs, such as heroin, or shared drug needles with someone else
An HIV viral load can find HIV in your blood within days after you’ve been infected. Other tests can take several weeks or months to show an infection. During that time, you could infect someone else without knowing it. An HIV viral load gives you results sooner, so you can avoid spreading the disease.
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The Identification Of Hiv Controllers
HIV Controllers After Post-Treatment Interruption
Although treatment interruption is usually accompanied by a rapid rebound in the VL, a special group of patients are able to control viremia for long periods of time after stopping HAART. In most cases, these patients were treated early during their primary infection. Although it is not possible to exclude that ART may have masked spontaneous control of infection in some cases, these controllers post-therapy seem in general to be different from HICs . Their HIV-specific CD8+ T cell responses are extremely weak, and their genetic background is different from that of HICs . It is thus possible that a prolonged period of ART in primary infection may allow some patients to develop mechanisms to control the virus off therapy.
Nina E Tolkoff-Rubin, Robert H Rubin, in, 2010
Viral Load And Cd4 Levels
When someone contracts HIV, the virus begins to take over specific cells in the immune system, called CD4 cells.
When the CD4 cells replicate, the HIV cells inside them also replicate. HIV hijacks the cellular machinery of CD4 cells to reproduce and shed more HIV, which means the viral load increases.
As the HIV viral load increases, the number of healthy CD4 cells decreases as they are destroyed creating HIV copies.
Treatment aims to produce a low viral load and a high CD4 count. When a person has achieved this, their HIV is well controlled.
A low or undetectable viral load means the virus is not progressing. It also means that HIV is not attacking the immune system as actively. This gives the immune system the chance to rebuild its healthy cell count. As a result, the number of CD4 cells in the persons body will increase as their viral falls.
For more in-depth information and resources on HIV and AIDS, visit our dedicated hub.
A doctor will usually test a persons viral levels when they first diagnose HIV. Doctors will recommend an HIV test if someone presents symptoms of HIV or if they may have come into contact with the virus.
People living with HIV will have repeat viral load tests throughout their lives to monitor the condition. They should get tested once every 3 to 4 months during treatment.
Additionally, a person should get tested due to any alteration in their medication or if their symptoms change.
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Viral Load If You Are Taking Hiv Treatment
Your viral load should start to fall once you start HIV treatment. Taking your treatment in the right way, every day, gives it the best chance of working. If you are having difficulty taking your treatment, for any reason, it is really important to talk to your doctor or another member of your healthcare team about it.
Your doctor will check your viral load within a month of starting treatment, and again three and six months after starting treatment.
Your viral load four weeks after starting HIV treatment is a good indicator of whether it will become undetectable on this combination of anti-HIV drugs.
The aim of HIV treatment is an undetectable viral load. Your viral load should have fallen to undetectable levels within three to six months of starting HIV treatment. If this doesnt happen, your doctor will talk to you about possible reasons for this and discuss what to do next.
Once you have an undetectable viral load, you will have your viral load monitored every three to four months. If you have had an undetectable viral load for some time and are doing well on treatment, your doctor may offer you the option to have your viral load measured every six months or every year.
Are Test Results Accurate
HIV viral load testing is a vital tool for monitoring the state of a patients HIV infection. To ensure accuracy in monitoring changes in a patients viral load over time, patients may be encouraged to have the same type of test conducted each time and, preferably, at the same laboratory.
There are several methods that may be used by laboratories to measure a patients HIV viral load. To ensure that test results can be compared and interpreted consistently over time, its best for patients to have the same type of viral load test each time. This helps to provide an accurate picture of whether the virus is replicating or stable with the current ART regimen.
A patients doctor can discuss how to ensure that the viral load testing method is consistent across multiple tests.
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What Is A Viral Load Test How Is It Used In Patients With Hiv
A test that measures the amount of HIV RNA in the plasma and indicates the degree of viral replication. Viral load testing is the single best prognostic indicator in HIV infection, with a higher level of mRNA indicative of a poorer prognosis. The test is routinely performed as part of the initial assessment of newly diagnosed HIV infection. Once therapy has been initiated, the viral load is used to assess the efficacy and durability of ART. There should be at least a 1.0-log decrease in the viral load within 8 weeks of the start of therapy. Within 24 weeks, the viral load should be below detectable limits.
Jessica S. Tischendorf, James M. Sosman, in, 2022
Viral Load Test Procedure
A doctor can test the viral load using a simple blood test. No preparation is needed.
The doctor or technician will draw a small amount of blood and send the sample to the labs to test the viral load and CD4 count.
It often takes a few days for the results to come back. Once they are back, the doctor will likely call to discuss the results with the individual.
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What To Expect From An Hiv Rna Test
There’s nothing you need to do to prepare for an HIV RNA test.
To perform the test, a healthcare provider will use a needle to collect a blood sample from a vein, usually in your arm.
Results from the test may indicate:
- No virus in the blood
- A low viral load, which may indicate that treatment is working
- A high viral load, which may indicate that HIV treatment is not working well, isn’t being taken, or that you may be at a higher risk for AIDS
After the test, you may experience slight discomfort and possible bruising where the needle was inserted into the arm.
When Should I Get An Hiv Viral Load Test
Diagnostic testing for HIV viral load may be used in patients with a possible or known exposure to the virus who are suspected of having an acute HIV infection. An acute HIV infection describes the earliest stage of HIV infection when some people begin to develop signs and symptoms of this disease. Although up to 60% of people infected will not have symptoms during this period, when they do occur symptoms of an acute HIV infection may include:
- Within 2 to 4 weeks after starting ART
- Every 4 to 8 weeks until the viral load is suppressed and undetectable
- Once the virus is undetectable, every 3 to 4 months during the first two years of ART
- Every 6 months in some patients who have undetectable viral loads for two years or longer
If a patient changes their ART regimen due to side effects or because their viral load is suppressed, an HIV viral load test may be ordered after 4 to 8 weeks to confirm the effectiveness of the new treatment regimen.
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