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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What Is An Undetectable Viral Load
FAST FACTS
- Taking antiretroviral treatment reduces the amount of HIV in your body.
- With proper adherence, ART can reduce HIV to such low levels that the virus can no longer be detected in normal blood tests. This is called having an undetectable viral load.
- People with undetectable viral loads cant pass HIV on through sex.
- To know that youre undetectable, you must have your viral load monitored regularly.
- Remember your viral load can change. If you stop taking your treatment properly your viral load will go up again.
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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.
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What Is The Life Expectancy For People Living With Hiv In The Uk
A study published in 2014 looked at the outcomes of over 20,000 adults who started HIV treatment in the UK, between 2000 and 2010. The analysis didnt include people who inject drugs, who tend to have poorer outcomes than other people, but otherwise included a wide range of adults living with HIV.
The key finding was that people who had a good initial response to HIV treatment had a better life expectancy than people in the general population.
Specifically, a 35-year-old man who had a CD4 cell count over 350 and an undetectable viral load one year after starting HIV treatment could expect to live to the age of 81. A 50-year-old man with the same results after one year of treatment was predicted to live to the age of 83. In the general population at this time, men in these age groups were expected to live to 77 and 78 years.
“A person living with HIV has a similar life expectancy to an HIV-negative person providing they are diagnosed in good time, have good access to medical care, and are able to adhere to their HIV treatment.”
A 35-year-old woman and a 50-year-old woman with the same results could expect to live to 83 and 85 years. This compares to 82 and 83 years in the general population.
A 35-year-old man with any of those results could expect to live to 70-72 years. A 50-year-old man was predicted to live to 75-77 years. Women of the same ages could expect to live around two years longer than the men.
Does U=u Apply To The Non
This page is about HIV transmission during sex.
But an undetectable viral load is also crucial for conception, pregnancy and birth. If you maintain an undetectable viral load during pregnancy, the risk of HIV being passed on to your baby is just 0.1%, or one in a thousand.
During breastfeeding, an undetectable viral load greatly reduces the risk of passing HIV on, although it does not completely eliminate this possibility. In the UK and other countries where clean water and sterilising equipment are available, bottle feeding with formula milk is the safest way to feed your baby.
If you use injection drugs and or other equipment, taking HIV treatment and having an undetectable viral load greatly reduces the risk of passing HIV on, but we dont know by how much.
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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
Viral Load And Hiv Transmission
A low viral load means a person is less likely to transmit HIV. But its important to note that the viral load test only measures the amount of HIV thats in the blood. An undetectable viral load doesnt mean HIV isnt present in the body.
HIV-positive people may want to consider precautions to lower the risk of HIV transmission and to reduce the transmission of other sexually transmitted infections .
Using condoms correctly and consistently when having sex is an effective STI prevention method. Check out this guide to using condoms.
Its also possible to transmit HIV to partners by sharing needles. Its never safe to share needles.
HIV-positive people may also want to consider having an open and honest discussion with their partner. They can ask their healthcare providers to explain viral load and the risks of HIV transmission.
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When Your Viral Load Is Undetectable
Eventually, you want to have an undetectable viral load — one so low that a lab test canât find it. When you have an undetectable viral load, you canât spread the virus to your sexual partner.
Even when you reach that point, you must remember that the virus is still in your body. To keep it at bay, take your medicine every day, just as your doctor prescribes. If you skip doses or stop treatment, your viral load can go up quickly. The chance that you can transmit the virus to your partners also goes way up.
Tell your doctor if you have trouble sticking to your treatment. Talk to your partners, too. Discuss other kinds of protection, like condoms, safer sex, or pre-exposure prophylaxis . This daily pill can lower the chance of infection in people who donât have HIV by up to 99%.
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 Hospital’s RAPID program gets patients started on antiretrovirals the same day they’re 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 aren’t given a prescription, and still others don’t take the medications or only take them sporadically.
The technology is there, Dr. Gandhi says, but it’s 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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How Will I Know If I Am Undetectable
You cant tell if you have an undetectable viral load simply by how healthy you look and feel. The only way to know that your viral load is undetectable is by regular viral load monitoring.
Viral load monitoring involves a simple blood test to measure how many particles of HIV there are in a small sample of your blood . From this you and your healthcare worker can understand how well your ART is working.
A low viral load means that your ART is working well and controlling your HIV. If you have an undetectable viral load, it means that the amount of HIV in your body is so low that you can’t pass it on to other people through sex.
The point at which a viral load is classified as being undetectable may vary across different countries depending on the tests available. But so long as your viral load is under 200 copies per millilitre, youre considered virally suppressed and unable to pass HIV on.
The frequency with which you are offered viral load testing may vary depending on where you are and the services available to you. The World Health Organization recommends that when first starting ART, you should have your viral load measured after the first 6 months of treatment and again at 12 months. After becoming undetectable you should still receive viral load testing at least every 12 months. Depending on the resources available and your particular health status, your health worker may recommend that your viral load is monitored more often than this.
How Does Being Durably Undetectable Affect My Risk Of Transmitting Hiv To A Sexual Partner
People living with HIV who take antiretroviral medications daily as prescribed and who achieve and then maintain an undetectable viral load have effectively no risk of sexually transmitting the virus to an HIV-negative partner.
Three large multinational research studies involving couples in which one partner was living with HIV and the other was notHPTN 052, PARTNER and Opposites Attractobserved no HIV transmission to the HIV-negative partner while the partner with HIV had a durably undetectable viral load. These studies followed approximately 3,000 male-female and male-male couples over many years while they did not use condoms. Over the course of the PARTNER and Opposites Attract studies, couples reported engaging in more than 74,000 condomless episodes of vaginal or anal intercourse.
Learn more about HIV treatment as prevention.
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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.
What Does It Mean To Be Durably Undetectable
Taking antiretroviral therapy daily as prescribed to suppress HIV levels leads to an undetectable status. A person is considered to have a durably undetectable viral load if their viral load remains undetectable for at least six months after their first undetectable test result. It is essential to continue to take every pill every day as directed to maintain an undetectable viral load.
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How Do We Know Treatment As Prevention Works
Large research studies with newer HIV medications have shown that treatment is prevention. These studies monitored thousands of male-female and male-male couples in which one partner has HIV and the other does not over several years. No HIV transmissions were observed when the HIV-positive partner was virally suppressed. This means that if you keep your viral load undetectable, there is effectively no risk of transmitting HIV to someone you have vaginal, anal, or oral sex with. Read about the scientific evidence.
Undetectable: Your Burning Questions Answered Get An Hiv Doctors Answers To Your Burning Questions About Undetectable Viral Loadand What It Means For Your Health And Your Sex Life
In 2013, BETA published an article about viral suppression and having an undetectable viral load. A lot has changed since the original article was published.
To keep us up-to-date, Barry Zingman, MD, the medical director of the AIDS Center at Montefiore Medical Center and professor of medicine at Albert Einstein College of Medicine joins us to answer our questions about what it means to be undetectable, the risk of HIV transmission, and more.
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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.