- 1 Undetectable viral load and NO transmission of HIV
The amount of HIV in body fluids is called the viral load. Effective HIV treatment (antiretroviral therapy) suppresses the amount of HIV in body fluids to the point where the standard tests are unable to detect HIV, or they may find only a tiny trace.
Have one Undetectable viral load does not mean that you are cured of HIV. If you stopped taking treatment, your viral load would increase and again it would be detectable.
Having an undetectable viral load means that there is not enough HIV in their body fluids to transmit HIV during sex. In other words, you are not infectious.
As long as your viral load remains undetectable, your chance of transmitting HIV to a sexual partner is zero. As the slogan of the campaign says, 'Undetectable is Untransmittable' or 'U = U'.
This fact sheet is written for people living with HIV. This topic is also covered in a fact sheet written for people who do not have HIV.
Viral load in different stages
During the first few weeks after someone get HIV, viral load is usually very high - typically several million "viral copies per milliliter of blood(Copies / ml). There is a considerable risk of transmitting HIV at this time. Indeed, many people get HIV from someone who has only recently acquired it (and does not know it).
After this period of early infection, the viral load generally decreases. A typical viral load in someone who is not receiving treatment may be 50.000 copies / ml. There is still a considerable risk of transmitting HIV.
After you start treatment for HIV, the viral load usually decreases rapidly. Within three to six months, most people's viral load became undetectable (below 50 copies / ml).
It is recommended that you wait until you have at least two consecutive undetectable results over a period of six months before you trust them. If you have had an undetectable viral load for at least six months and continue to have good accession, the British HIV Association says there is no risk of HIV transmission.
British HIV Association Council
The 'Undetectable equals non-transmissible' campaign (U = U) is supported by the British HIV Association (BHIVA), which is the professional association for doctors and other health professionals working with HIV in the UK.
BHIVA says that consistent use of HIV treatment to maintain an undetectable viral load is a highly effective way to prevent the sexual transmission of HIV.
BHIVA says health professionals should share this information with all people living with HIV. Advises health professionals to explain the scientific evidence behind U = U, emphasizing the importance of excellent adherence to HIV treatment and emphasizing that U = U is dependent on maintaining an undetectable sustained viral load.
The scientific evidence
The first large study indicating that people with low viral loads are not infectious came from a study of 415 heterosexual couples in the 2000 year. This found that no HIV-positive partner with a viral load below 1500 copies / ml transmitted HIV.
In 2011, a large scientific study called HPTN 052 concluded that HIV treatment reduced the risk of transmitting HIV to a regular heterosexual partner in 96%. The only reason it was not 100% is that a person in the study got HIV, but this happened a few days after their partner started treatment. Over the course of the four-year study, no person with undetectable viral load transmitted HIV to the partner.
PARTNER 1 and PARTNER 2 Studies
Between the two, they recruited 972 gay couples and 516 heterosexual couples in which one partner had HIV and the other did not. Throughout the study, gay couples had 77.000 acts of sex without penetration and heterosexual couples 36.000 acts. PARTNER studies did not find a single HIV transmission from an HIV-positive partner who had an undetectable viral load (below 200 copies / ml).
In 2017, a similar study with exclusivity of 343 gay couples, Opposites Attract, also found no partner transmissions with undetectable viral load in 17.000 acts of anal sex without a condom.
No HIV Transmission of a Sexual Partner with Undetectable Viral Load
Among the three studies, no HIV transmission from a sex partner with undetectable viral load was observed in almost 130.000 acts of sexual penetration without a condom. This means that the risk of transmission by a partner with an undetectable viral load is statistically equivalent to zero.
Some of the HIV-negative partners in these studies did acquire HIV. But using genetic tests, the researchers were able to show that all of these infections came from other people and not from their main partner.
What this means to me?
Many people with HIV view the non-infectious side of relief in anxiety about transmission as a very important benefit of HIV treatment. Increasing public awareness of U = U can also reduce stigma in relation to people living with HIV.
If you want to stop using Condoms, it is probably a good idea to discuss this with your partners and see if they are comfortable with the decision. Likewise, if your partner is using the PrEP (pre-exposure prophylaxis), but you feel that you no longer need to, you will need to discuss it with them.
Discussing what an undetectable viral load means with seronegative partners can help reduce anxiety about HIV transmission. But this information will probably be new to most people who do not have HIV and it may take some time for someone to understand and trust what you are saying.
NAM has also produced a fact sheet for people who do not have HIV to help them understand the impact of an undetectable viral load on HIV transmission.
Knowing that “Undetectable equals non-transferable” is especially useful for people who wish to have a child. Couples in which one person has undetectable HIV and the other is HIV negative can have unprotected sex to conceive.
However, the HIV law may not have reached science. In some countries, sex without a condom without disclosing their HIV status is a crime regardless of the likelihood of HIV transmission. For specific country information, visit criminalisation.gnpplus.net
And Sexually Transmitted Infections (STDs)?
It is important to remember that while HIV treatment protects your partners from HIV, it does not protect them or you from other sexually transmitted infections (STDs). For this reason, sexual health checkup is recommended.
Condom Use Will Help Prevent STDs.
Another concern is whether having an STI can lead to an increase in viral load. This happens to people with HIV who are not receiving treatment: for example, syphilis can double your viral load. HIV-negative partners are also more likely to get HIV if they have an STI.
But it is not the case for people on HIV treatment who have an undetectable viral load. In the PARTNER and Opposites Attract studies, there was no single HIV transmission, although many people have STIs.
If you maintain good adherence to HIV treatment, detecting an STI will not increase your viral load from “undetectable” to “detectable”. Effective treatment prevents sexual transmission of HIV, even if other STDs are present.
If I have an undetectable viral load, I can HIV?
People with an undetectable viral load sometimes experience so-called "beeps" in their viral load. Its viral load increases from undetectable to a low but detectable level, before becoming undetectable again in the next test.
For example, viral load may temporarily increase to 60 copies / ml or 150 copies / ml. This should not be a cause for concern.
Remember that in the PARTNER and Opposites Attract studies, 'undetectable' was defined as below 200 copies / ml. These studies have shown that transmission does not occur below this level.
However, a blip may indicate a problem if it occurs more or less at the same time as missed or late doses of your medication, or if your viral load remains above detectable on two consecutive tests.
Is Viral Load In Semen, Vaginal Fluids, Or Straight Is Not More Important Than Viral Load In Blood?
The viral load in your blood and other body fluids is usually very similar - if HIV in your blood is undetectable, it is likely to be undetectable elsewhere. Occasionally, people have undetectable HIV in their blood and have low levels of HIV in other body fluids, but very rarely at infectious levels.
Does HIV Treatment Always Work?
About one in six people on their first HIV treatment regimen never have an undetectable viral load or their treatment stops working in the first year. During the second year of treatment, the chance of your therapy ceasing to work is one in twenty and that decreases further in the next decade to about a chance in 50 of failure in any year.
So the longer you are on HIV-specific therapy, the less likely you are to stop working. Almost everyone who goes on to a second or third regimen reduces their viral load to an undetectable level.
Membership is Most Important
If someone's treatment does not make the viral load become undetectable, this is usually because they are having trouble taking the treatment as prescribed, meaning they do not take all of their pills at the right time without losing doses. If you are having trouble keeping your treatment, talk to your doctor and they will be able to find a combination of medications that suits you best.
U = U Applies To All Types Of Sex?
An undetectable viral load will prevent the transmission of HIV during the oral sex, vaginal sex and anal sex. Condoms are not needed to prevent HIV transmission when your viral load is undetectable.
Does U = U Apply to Non-Sexual Transmission of HIV?
This page is about HIV transmission during sex.
But an undetectable viral load is also crucial for conception, pregnancy and birth. If you have an undetectable viral load during pregnancy, the risk of being transmitted to your baby is only 0,1%, or one in a thousand.
During breast-feeding, an undetectable viral load greatly reduces the risk of HIV transmission, although it does not completely eliminate this possibility. In the UK and other countries where clean water and sterilization equipment is available, the milk-fed bottle is the safest way to feed your baby.
If you use injectable drugs and share needles or other equipment, HIV treatment and undetectable viral load greatly reduces the risk of HIV transmission, but we do not know how much.
This data sheet should be reviewed in January of 2022