Things To Know About Hiv Suppression
A vial of blood
A vial of blood
Development of antiretroviral drugs to treat HIV has turned what was once an almost always fatal infection into a manageable chronic condition. Daily antiretroviral therapy can reduce the amount of HIV in the blood to levels that are undetectable with standard tests. Staying on treatment is crucial to keep the virus suppressed. NIAID-supported research has demonstrated that achieving and maintaining a durably undetectable viral load not only preserves the health of the person living with HIV, but also prevents sexual transmission of the virus to an HIV-negative partner.
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The very latest research is showing that it is highly unlikely for people with an undetectable viral load to transmit the virus to a sexual partner even without the use of a condom. Individuals who are optimally treated who have undetectable viral loads, who responsibly use protection have an incredibly low its incredibly rare to transmit the virus, Huizenga told Todays Matt Lauer. Indeed, this summer, the results of a large international study showed that early treatment reduces the risk of transmission by 93 per cent. We cant say that thats zero, Huizenga said, but its a very, very low level.
Beyond that, an ongoing study in the UK is following 1,110 couples, in which one partner has HIV and the other does not. The HIV-positive participants in the study are all using anti-retroviral therapy to suppress the virus, and some of the couples are having sex without condoms. In a presentation at the Conference on Retroviruses and Opportunistic Infections in March last year, lead researcher Alison Rodger announced the remarkable results of the study so far: In two years, there were no instances of transmission of the virus between partners in the study and thats including the couples who were not using condoms. In an answer to a question about what this study suggests about the chance of a person with an undetectable viral load transmitting HIV to a sexual partner, Rodgers replied, Our best estimate is it’s zero.”
Do I Still Need To Worry About Other Sexually Transmitted Infections
Neither HIV treatment nor PrEP prevents other sexually transmitted infections, or STIs.
Ways to reduce the risk of STIs include having both partners tested, limiting the number of sexual partners and using condoms. Vaccines are available to prevent some STIs, including hepatitis B and human papillomavirus .
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About Undetectable And Hiv
Chances are youve probably heard of the term undetectable, undetectable viral load or UVL when chatting to friends or potential sexual partners, on apps or social media, or in blogs, magazines and medical journals.
But, what does it mean?
Having an undetectable viral load not only improves a HIV positive guys overall health, but it also means he wont transmit HIV to his partners. When a HIV positive guy is on treatment, within six months he can, in most cases, achieve an UVL.
What If I Am Undetectable And I Use Injection Drugs
If you are undetectable and use injection drugs, your chances of sexually transmitting HIV are negligible. However, even with an undetectable viral load, anyone who injects drugs should always use clean/new equipment and never share works. U=U does not apply at all to HIV transmission with shared works. While stigma as well as inadequate and intermittent health care remain challenges for many people with a history of injection drug use who are living with HIV, it is still important for them to remain engaged in medical care to become virally suppressed.
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What Does Negligible Risk Mean
Negligible risk means so small or unimportant as to be not worth considering insignificant, having effectively no risk of sexually transmitting the virus. For U=U, “risk” is a projection talking about chances of something happening in the future and cannot be quantified, or given an exact number. What can be said for sure is that there have been zero transmissions in studies so far. And those studies included tens of thousands of unprotected sex acts. Undetectable individuals do not transmit HIV sexually, so the risk of transmission is negligible.
How Long Do I Need To Be On Art And Be Undetectable In Order Not To Transmit Hiv
First, being on ART and being undetectable are two different things. When you start on ART, it takes a while for the medication to do its job. Generally, if the ART is working, it should reduce the amount of virus in your blood to an undetectable level within a few months. Once you are undetectable , you then need to stay undetectable for at least six months before your HIV is considered “untransmittable.” In other words, you need at least two confirmatory tests that your viral load is less than 200 copies/mL – at the beginning and the end of a six-month period – before you can use your undetectable status as a method of HIV prevention.
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Thats Good News For All
Undetectable viral load is game-changing news for both poz and neg guys. If youre HIV poz, undetectable comes with amazing health benefits as well as the assurance that you are keeping the guys you play with safe.
And if youre neg, having sex with a poz guy whos undetectable can give you the confidence that you wont get HIV. UVL puts safety first for everyone.
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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Suppressed Viral Load And Undetectableis There A Distinction Is There A Difference In Transmission Risk With A Viral Load Of 200 Copies/ml Vs 20 Copies/ml
When it comes to transmission risk, there is no difference between suppressed viral load and undetectable viral load. As long as your viral load is below 200 copies/mL, and has stayed that way for at least six months, your risk of sexually transmitting HIV remains negligible.
The word “undetectable” comes from the sensitivity of the laboratory viral load assay used. Even if the viral load test could not detect virus in the blood sample, it does not mean HIV has disappeared from the body, but that ART has suppressed the virus so much that the usual lab tests cannot “detect” or find it.
“Undetectable” is now commonly defined as having fewer than 20 copies/mL because a lot of lab tests can now “detect” HIV at that level. And “ viral load suppression” is usually defined as having fewer than 200 copies of HIV per milliliter of blood . However, in the context of U=U, the two terms can be used interchangeably: a person is considered undetectable if they have reached viral load suppression of fewer than 200 copies/mL.
Hiv Positive And Undetectable: What Does It Mean
Being undetectable means that there is so little HIV in your blood that the virus cannot be detected by a standard blood test. An undetectable viral load generally means there are fewer than 40 viral copies per millilitre of blood.1
As long as you are able to stick to your treatment regimen and your viral load remains undetectable for 6 months after starting your treatments , then you cannot pass on HIV to others:
Undetectable = Untransmittable.1
HIV and the immune system
CD4 cells are white blood cells, which are an important part of your immune system as they help to fight infections.2
Normally, a CD4 cell count is around 500 to 1,500 cells per cubic millimetre of blood. Without treatment, HIV infects and destroys CD4 cells, depleting the amount a person has and weakening their immune system.2
- A CD4 counts > 500 cells indicates a fairly normal immune system and means the risk of opportunistic infections is low2
- A CD4 counts < 200 cells indicates a diagnosis of AIDS and means that there is a risk of developing serious opportunistic infections2
People with a high viral load are likely to have low CD4 counts.
Having a high viral load also increases the risk of passing HIV to others.1
Being undetectable is a great step in managing your HIV
Having an undetectable viral load level eliminates the risk of passing HIV onto others and minimises the risk of HIV-related infections and disease.1
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What Will Being Undetectable Mean For Me
Having an undetectable viral load means that your ART is effectively controlling your HIV. This will protect your immune system and help you to stay in good health.
Being undetectable also means that you dont have to worry about passing HIV onto your sexual partners. For many people this is just as important to them, giving them relief from the anxiety of passing HIV on. Some people find that knowing theyre undetectable makes it easier to with others, as it can be reassuring for others to know that your health is protected and you cant pass it on too.
Being Undetectable: Good News
You can live a healthier and longer life. If you have an undetectable viral load, it means that there is less HIV in your body. Being undetectable means that the virus is less able to attack your immune system cells, which means that there will be less damage to your immune system. This allows people to stay healthier and and live longer.
Undetectable = Untransmittable. People who are undetectable do not transmit HIV to other people through sex. That is the meaning of undetectable = untransmittable or U=U, a message started by Prevention Access Campaign about what it means to be undetectable. If you have been taking HIV medications for at least six months, have a consistently suppressed viral load , and continue taking your HIV medications as directed, you will not transmit HIV to others.
Treatment as Prevention . Treatment as prevention refers to taking HIV medications to prevent the sexual transmission of HIV. As with U=U, people living with HIV who maintain undetectable viral loads do not transmit HIV to other people.
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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
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Hiv Undetectable=untransmittable Or Treatment As Prevention
In recent years, an overwhelming body of clinical evidence has firmly established the HIV Undetectable=Untransmittable, or U=U, concept as scientifically sound. U=U means that people with HIV who achieve and maintain an undetectable viral loadthe amount of HIV in the bloodby taking antiretroviral therapy daily as prescribed cannot sexually transmit the virus to others. Thus, treatment for HIV is a powerful arrow in the quiver of HIV prevention tools. Read more about how a durably undetectable viral load prevents HIV transmission with NIAID’s fact sheet 10 Things to Know About HIV Suppression.
For nearly two decades, scientists have recognized that viral load is a key determinant of HIV transmission. Studies conducted before the availability of ART revealed that higher viral loads correlate with higher rates of both sexual and perinatal transmission of HIV. Following the advent of triple-drug ART in 1996, observational studies suggested that viral loads lowered by ART were associated with reduced risk of sexual and perinatal HIV transmission. In addition, epidemiological studies showed that as the number of people in a community who are virally suppressed rises, the number of new HIV transmissions falls.
To read more about the underlying science and the value of U=U, see NIAIDs blog post Science Validates Undetectable=Untransmittable HIV Prevention Message.
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How Do We Know That Undetectable = Untransmittable
Three recent studies âHPTN 052, PARTNER and Opposites Attractâ 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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If My Partner Tells Me They Have An Undetectable Viral Load Should We Still Use Condoms
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.
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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.
What Does Undetectable Equals Untransmittable Mean
U=U is the name of a public health campaign that has really taken off in the last year and is accepted and endorsed by organizations worldwide. It shares the message that people who are undetectable do not transmit HIV to other people.
This campaign promotes key medical information that is important for people living with HIV to know, but it is also an important concept that reduces HIV stigma in the community. The phrase really encompasses an idea that people who are living with HIV can be free from HIV stigma, and can live their lives more fully, with less fear, worry, and inhibition.
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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.
After I Begin Hiv Treatment How Long Does It Take For The Risk Of Sexually Transmitting Hiv To Become Effectively Zero
There is effectively no risk of sexual transmission of HIV when the partner living with HIV has achieved an undetectable viral load and then maintained it for at least six months. Most people living with HIV who start taking antiretroviral therapy daily as prescribed achieve an undetectable viral load within one to six months after beginning treatment.
A persons viral load is considered durably undetectable when all viral load test results are undetectable for at least six months after their first undetectable test result. This means that most people will need to be on treatment for 7 to 12 months to have a durably undetectable viral load. It is essential to take every pill every day to maintain durably undetectable status.
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