What Is Viral Suppression
Antiretroviral therapy keeps HIV from making copies of itself. When a person living with HIV begins an antiretroviral treatment regimen, their viral load drops. For almost everyone who starts taking their HIV medication daily as prescribed, viral load will drop to an undetectable level in six months or less. Continuing to take HIV medications as directed is imperative to stay undetectable.
How Is Hiv Treated
It is recommended that all individuals diagnosed with HIV infection receive antiretroviral treatment as soon as possible, including pregnant women. People typically take at least three drugs from two different classes in order to prevent or minimize virus replication and the emergence of drug-resistant strains. Combinations of three or more antiretroviral drugs are referred to as highly active antiretroviral therapy or HAART.
Why It Is Good To Have An Undetectable Viral Load
Having an undetectable viral load is important for a number of reasons.
First of all, because your immune system is able to recover and become stronger, it means that you have a very low risk of becoming ill because of HIV. It also reduces your risk of developing some other serious illnesses as well. There is some evidence that the presence of HIV can increase the risk of cardiovascular disease .
Secondly, having an undetectable viral load means that the risk of HIV becoming resistant to the anti-HIV drugs you are taking is very small.
Finally, having an undetectable viral load means that you will not pass HIV on during sex.
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Point Of Care Laboratory
VL determination in small, low throughput laboratories is not a realistic option with the current methodologies. Rather, patients should be referred to regional or central laboratories. Alternatively, finger-prick blood samples could be sent to the central reference laboratories by using special anticoagulated blood sampling PPT-tubes or by dried blood spot/dried plasma spot technology.22 The advantage of this method is that samples can be stored for prolonged time periods . Shipment can be done at ambient temperatures by normal mail , RNA can be isolated and tested in batches, which reduces costs. Several VL technologies can accommodate DBS/DPS, including the Rainbow real time Primagen Rainbow NASBA, the Roche Amplicor HIV-1 Monitor and the bioMerieux NucliSens HIV-1 QT assays, although the protocols have not been formalized yet. DBS/DPS sampling thus increases the action radius and efficiency of central reference labs. There are some reports that DBS/DPS works very well for pediatric applications, but the small sample size might collect too few events for reliable measurement of adult VL . This problem might be overcome by the Sample Tanker that can accommodate 1 mL of plasma sample and allows for shipment at ambient temperatures.23
Amitava Dasgupta PhD, DABCC, Amer Wahed MD, in, 2014
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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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.
So Is There Such A Thing As A Normal Viral Load
When laboratory results like a cholesterol level or white blood cell count come back, we often hear that they are “normal” or “in the normal range.” However, with HIV, defining a “normal” viral load is difficult. For one thing, having a detectable HIV viral load is itself not a normal lab test result, given that the vast majority of people in the world are not living with HIV.
In addition, people who are living with HIV but who are not yet on HIV treatment will not usually have the same viral load level as people who are living with HIV and are on treatment. Among HIV-positive people, viral load can range from just a few copies to several hundred thousand, or even millions.
Complicating things further is that the amount of viral load usually doesn’t correlate with how people may feel, even though higher viral loads are a marker of faster progression of HIV infection. And regardless of where their viral load was before they started treatment, once people start and stay on HIV medications, the viral load should become undetectable. Thus, I would be reluctant to put a number, or even a range, on what we should define as a “normal” viral load.
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When Do I Need An Hiv
This test is meant for treatment and monitoring of HIV-1 positive patients. A Viral Load test will be carried out after initial diagnosis to form a baseline. Another test to be done at the start of HIV treatment with a follow up 1 month after. And then every 3-6 months.
This test is not a diagnostic test, however, in some cases, it is helpful in excluding in diagnosis of HIV-1 in cases where 4th generation antigen & antibody tests are equivocal.
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.
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What Are Other Factors That Affect Cd4 Count
HIV is not the only factor affecting CD4 levels.
The following can also have an impact:
- Circadian rhythms, also called the body clock, vary during the day. One result of this is that CD4 levels tend to be lower in the morning and higher as the day progresses.
- Having an infection, such as the flu, pneumonia, or hepatitis B, can cause CD4 levels to fall.
- Some treatments, such as chemotherapy or single-dose steroids can cause CD4 levels to drop. However, ongoing steroid use may increase CD4 levels.
Other factors that may play a role include:
- nicotine or alcohol use
For this reason, there may be some variation in CD4 levels, even if a persons health status has not changed. Also, the CD4 level will not affect how a person feels. Some people have low CD4 levels and function well, while others experience complications despite having higher levels.
Can My Viral Load Continue To Change
Yes, your viral load can continue to change. This would usually be a result of factors to do with your adherence , or other health issues. Regular viral load monitoring will help you stay on top of these changes, so you can manage your health accordingly.
Your viral load usually drops quickly after first starting treatment, however it may be a while before it reaches a point where its undetectable. Most people who adhere properly to their treatment become undetectable after about six months, but its important that you have a viral load test to confirm this.
While changes to viral load can occur, they should be relatively uncommon for people who adhere properly to their medication and are otherwise in good health. Your viral load monitoring appointments are there to help you to identify and respond to any changes in your viral load.
These appointments also give you time to discuss any difficulties you are having with your medication. Often big life changes, like starting a new relationship or moving to a new place, can make adherence more difficult. Your healthcare worker can help you with any new challenges and work with you to stay healthy and keep your viral load low.
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Provision Of Hiv Viral Load Testing Services In Zimbabwe: Secondary Data Analyses Using Data From Health Facilities Using The Electronic Patient Monitoring System
Affiliations Department of HIV and TB, Ministry of Health and Child Care, Harare, Zimbabwe, Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
- Kudakwashe C. Takarinda,
Roles Data curation, Formal analysis, Validation, Visualization, Writing review & editing
Affiliations Department of HIV and TB, Ministry of Health and Child Care, Harare, Zimbabwe, Centre for Operations Research, International Union Against TB and Lung Disease, Paris, France
Roles Conceptualization, Methodology, Supervision, Visualization, Writing review & editing
Affiliation Institute for Global Health, UCL, London, United Kingdom
Roles Conceptualization, Methodology, Supervision, Writing review & editing
Affiliation Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
- Frances M. Cowan
Roles Conceptualization, Methodology, Supervision, Writing review & editing
Affiliations Centre for Sexual Health and HIV/AIDS Research , Harare, Zimbabwe, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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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How Is It Different From The Hiv
The HIV-1 Viral Load test is a quantitative test that tells us the amount of HIV virus in the blood sample. This test is done in those who are known to be HIV positive and is a way of monitoring their infectiousness and response to HIV treatment.
The HIV-1 Qual DNA test is a qualitative test and identifies whether someone is HIV positive or negative.
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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An Increasing Number Of Patients On Antiretroviral Therapy
4In response to its precarious HIV situation, the Government of Laos PDR has provided strong political commitment to support a multi-sectorial response. The action of key international and national partners has been also invaluable. Médecins Sans Frontières opened its HIV/AIDS project in Savannakhet, southern Laos PDR, in 2001. Along with providing urgently needed treatment, the project aimed to sensitize the general public and the authorities to the existence of HIV/AIDS and the need for specialized care. MSFs project offered free services for patients, who until recently travelled from all provinces to benefit from them. In Savannakhet, MSF provided prophylaxis and treatment for opportunistic infections and ART. By 2007, HIV counselling, testing and ART services had been handed over to the hospital. By the end of 2007, 608 patients were receiving care and treatment, with 490 of them on ART.
6To date, seven centres have been gradually established: two in Vientiane , 3 in the north and two in the south . At the end of 2011 the number of patients receiving ART was estimated at 2,115.
Cd4 Count Vs Viral Load
Theres no direct relationship between CD4 count and viral load.
In the past, doctors used the CD4 count as an indicator of when to start therapy, but advances in HIV medication have changed this. Now it serves as an indicator of immune system stability.
However, in general, a high CD4 count and a low or undetectable viral load are desirable. The higher the CD4 count, the healthier the immune system. The lower the viral load, the likelier it is that HIV therapy is working.
When HIV invades healthy CD4 cells, the virus uses them to make new copies of HIV before destroying them. When HIV remains untreated, the CD4 count decreases, and the viral load increases.
The following chart gives a general idea of what the levels of CD4 and viral load mean for a person with HIV, based on guidelines from the U.S. Department of Health and Human Services.
|How serious is this?|
|After levels remain stable for 2 years.||Up to 6 months interval|
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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.
Can An Hiv Rna Test Be Used To Screen For Hiv
The recommended test for HIV screening is a combination test that detects HIV antibody and HIV antigen. By detecting both antibody and antigen, the combination test increases the likelihood that an infection is detected soon after exposure. Most HIV screening tests detect only HIV antibody but are good options for screening because they may be available as rapid tests and at the point of care. If any of these screening tests are positive, they must be followed by another different antibody test. If the second test is positive, then HIV diagnosis is confirmed. If, however, the first and second result do not match, then an HIV RNA test may be done to help establish a diagnosis.
The recommended screening test for newborns, however, is an HIV RNA test .
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Quality Improvement Collaborative Implementation
Quality improvement collaborative teams from the 30 participating HFs attended the first learning session in March 2017. The 5-day workshop provided participants with a practical refresher training on modern QI science tools, including the model for improvement and plan-do-study-act cycle methodology. Participants also consolidated their knowledge of how to perform root cause analyses using fishbone diagramming and process mapping and generated change ideas based on the system weaknesses, bottlenecks, and gaps they identified. The HF QI teams then prioritized potential change ideas using a prioritization matrix and practiced tracking progress with run charts. Each team left the first learning session with a well-constructed QI plan with which to implement and test their first change ideas.
After the first learning session, monthly supportive supervision visits were made to each facility by ICAP staff in collaboration with MoH/NASCOP, CHS, and CHMT. During supportive supervision visits, ICAP staff met with facility-based QI teams to review implemented change ideas and their effect on progress toward achieving the shared aims. As a group, they used data to make decisions about which change ideas to adopt into routine practice, which to adapt for further testing, and which to abandon.