How Is The Test Used
The HIV viral load test is used initially, along with a CD4 count, to determine the status of your HIV infection when you have been diagnosed with the disease. The viral load is then used to monitor the effectiveness of your antiretroviral treatment over time.
The HIV viral load may also be used to help determine whether the virus infecting you has become drug-resistant. If you do not respond well to treatment and the amount of virus continues to increase, then the virus may be resistant to that particular ART. Your treatment will then likely be modified.
HIV viral load tests are most useful when they are compared with results obtained from your earlier tests. They are used in combination with the CD4 count to monitor how effective ART is in suppressing your HIV.
Benefits Of Undetectable Hiv
When you have an undetectable viral load, you can almost live as though you dont have HIV. The benefits include:
- Low risk of advancing to AIDS
- Normal levels of CD4 T cells, which reduces your susceptibility to other illnesses
- Lower risk of transmitting to others through sex or IV drug use
- Ability to have a relatively normal sex life with a partner with a low risk of transmission
- Lower risk of premature death from HIV/AIDS
Of course, these benefits rely on your consistency when taking your HIV medications. Missed doses may result in a viral load blip, or an increase in your HIV viral load. When this happens, you may have a higher risk of transmitting HIV to others or contracting infections.
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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Never Share Needles Syringes Or Other Drug Injection Equipment
- Use new, clean syringes and injection equipment every time you inject.
- Many communities have syringe services programs where you can get new needles and syringes and safely dispose of used ones. SSPs can also link you to substance use disorder treatment, testing, and care and treatment for infectious diseases.
- Some pharmacies sell needles without a prescription.
How can I protect my baby?
What Does Undetectable Viral Load Mean
Antiretroviral therapy is medication that helps to keep the viral load in the body under control. For many people, HIV treatment can substantially lower viral load levels, sometimes to undetectable levels.
A viral load is considered undetectable if a test cant quantify the HIV particles in 1 milliliter of the blood. If a viral load is considered undetectable, it means the medication is working.
According to the Centers for Disease Control and Prevention , a person with an undetectable viral load has effectively no risk of sexually transmitting HIV. In 2016, the Prevention Access Campaign launched the U=U, or Undetectable = Untransmittable, campaign.
A word of caution: undetectable doesnt mean the virus particles arent there, or that a person no longer has HIV. It simply means that the viral load is so low that the test is unable to measure it.
HIV-positive people should consider continuing on antiretroviral medications to remain healthy and keep their viral loads undetectable.
Studiesshow that there may be temporary viral load spikes, sometimes called blips. These spikes can happen even in people whove had undetectable viral load levels for an extended period.
These increased viral loads may occur between tests, and there may be no symptoms.
Viral load levels in blood or genital fluids or secretions are often similar.
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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.
How Do We Know That Undetectable = Untransmittable
Three recent studies — HPTN 052, PARTNER and Opposites Attract — followed male couples and heterosexual couples in which one partner was HIV-positive and the other HIV-negative. During these studies, not one HIV-positive person who was taking antiretroviral medicines and was virally suppressed passed HIV to their negative partner. In the PARTNER and Opposites Attract studies, male couples had anal sex without condoms more than 34,000 times and heterosexual couples had vaginal or anal sex without condoms more than 36,000 times without a virally suppressed partner ever passing HIV to the negative partner. This is strong evidence that people do not sexually transmit HIV if they have an undetectable viral load.
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No Risk Of Hiv Transmission Really
So is it true that if a HIV positive partner is on treatment and has a UVL sustained , then there is no risk of HIV transmission?
Yes!
In 2016, the PARTNER study from Europe found that the chance of HIV transmission where one partner had a UVL is negligible. In fact, there were zero partner-transmissions recorded in the study despite approximately 22,000 acts of condomless sex by gay couples. Additionally, PARTNER2 the extension study of PARTNER that aimed to gather data pertaining to mixed-HIV-status gay male couples found that after an additional 54,000 acts of condomless sex there were zero transmissions.
This is also supported by a large international study, led by the Kirby Institute here in Australia, the Opposites Attract study, which focused solely on gay and other men who have sex men from Australia, Brazil and Thailand, confirmed that HIV positive men who are on treatment and have an undetectable viral load do not transmit the virus to their partners.
So, between these two studies there has was a combined total of over 89,000 acts of condomless sex occurred between gay couples with zero transmissions!
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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If My Partner Tells Me They Have An Undetectable Viral Load Should We Still Use Condoms
Having an undetectable viral load only prevents HIV transmission. Condoms protect against HIV, other sexually transmitted infections and unintended pregnancy.
If you are unsure about whether your partner is undetectable, take steps to protect yourself from HIV, such as using condoms or taking daily PrEP .
You should never feel pressured to have sex without condoms.
What You Need To Know
- A viral load test measures the number of copies of the virus in your blood. It is reported as copies/ml.
- Viral load is a sign of how active HIV is in your body. A lower number means the virus is less active.
- You will have your viral load tested regularly.
- Even low levels of HIV in the body can cause inflammation and cause damage. This is one reason why early treatment is now recommended.
- If you are taking ART and have an undetectable viral load you are significantly less likely to transmit HIV to others
- If you are taking HIV treatment, a consistent increase in your viral load may be a sign that the virus is developing resistance to one of your anti-HIV drugs. You and your doctor will discuss what to do next.
McLay D, Knowles Z
2017
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What Does Undetectable Mean
Your viral load test shows how much HIV there is in a small sample of your blood. With effective HIV treatment, your viral load will start to decrease over time. When your viral load is below 200 copies/ml, you may get viral load test results back, saying undetectable. This means the amount of virus in your sample was too little to be measured by the tests.
Depending on where you live and the test used, your results may be reported as < 200, < 50, target not detected, ND, zero, below the undetectable limit or negative. All of these terms mean your viral load is undetectable.
Undetectable viral load does not mean you are cured, or you can stop taking your HIV medication. There is still HIV in your body, but there is very little virus in your bloodstream and body fluids.
Undetectable viral load shows that HIV treatment is working. People who have an undetectable viral load are unlikely to get ill due to HIV, have better long-term health and longer life expectancy than those who dont.
Studies show undetectable viral load means zero risk of HIV transmission between sexual partners. With very little to no HIV in body fluids, people with HIV who have sustained an undetectable viral load for at least six months cannot pass HIV to their partners, even with no condom use.
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.
detectable viral load
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.
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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.
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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If Im Undetectable Is There A Chance My Viral Load Will Become Detectable Again
Being undetectable does not mean that you are cured of HIV. There are three instances when your HIV viral load might come back and be detectable again.
The most common instances are so-called viral blips. Blips are when your HIV levels become slightly detectable, but at a very low level, and then goes back to being undetectable again. People may experience viral blips when they take their HIV medications every day. Viral blips are usually due to issues in the lab, such as some slight error in the test or in the test conditions in the lab. Occasionally they are due to a slight but true increase in the viral load due to a stress such as an illness or a vaccine. Viral blips, in which the viral load goes right back down to undetectable soon, are considered harmless. There is no appreciable chance that a person with a viral blip will transmit HIV to another person.
People also become detectable when they stop taking their HIV medications or take them only partially. It may take between a week to several weeks after stopping HIV treatment for HIV to become detectable again, but people will see the levels of virus in their body go up to detectable levels.
Medications To Achieve Undetectable Levels
For people who are newly diagnosed, there are five different types of medication that can treat HIV, some of which are used in combination with others. Once a person finds the right regimen, it typically takes three to six months to suppress the virus to an undetectable level, according to the U.S. Department of Health and Human Services.
Some experts say that HIV medications can work even faster. Monica Gandhi, MD, MPH, an infectious-diseases physician at the University of California at San Francisco, says that San Francisco General Hospitals RAPID program gets patients started on antiretrovirals the same day theyre diagnosed and that some people achieve undetectable status in two months or less.
Unfortunately, some barriers prevent people with HIV from achieving a suppressed virus. Some infected people dont know they have HIV, others arent given a prescription, and still others dont take the medications or only take them sporadically.
The technology is there, Dr. Gandhi says, but its a question of access and compliance.
But for a individual who goes to see a doctor, Gandhi adds, they have a 100 percent chance of finding a regimen that, if taken every day, will suppress their viral load.
Thats good news, both for people with HIV and for their partners. But to maintain an undetectable status, the HIV-positive partner must stick to his or her ART regimen, and only the partner with HIV can make that commitment.
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