Undetectable Viral Load? the question is: what now?Some time ago, BETA magazine's Betablog published an article on viral suppression and undetectable viral load. A lot has changed since the original article was published. To keep us updated, Barry Zingman, MD, medical director of the Montefiore Medical Center AIDS Center. He is a professor of medicine at the Albert Einstein School of Medicine. and joined with us to answer our questions about what it means to be undetectable. And it talks a little more about the risks of HIV transmission, and more.
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 test or HIV DNA that your doctor or healthcare professional 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 test's detection limit, then we say that your virus is "undetectable".
If my viral load is undetectable, can I transmit HIV to others?I am very happy to say that we know the answer to that. If you are undetectable, and have been on HIV medications for at least six months, and continue this treatment, the risk of HIV transmission is effectively zero. This finding has been well established in the last six to seven years by multiple research studies. After studying thousands of couples over many years, research has shown that if a person living with HIV has been using HIV for at least six months, is undetectable and remains on their HIV drugs, they will not transmit HIV to other people.
Does Undetectable Viral Load apply to people who have anal sex?Yes. If a person living with HIV is taking HIV medication and has been undetectable for at least six months, they will not transmit HIV to anal sex partners (and it does not matter if they are the top or bottom). We know that this is true in research with thousands of episodes of people having anal sex, with many years of follow-up.
What about oral sex?Unless there's blood in your mouth, don't there is a risk of HIV transmission during oral sex. So, if you are living with HIV, and it is not detectable, you will not transmit HIV to a partner during oral sex.
If I am undetectable, is there a chance that my viral load will become detectable again?Being undetectable does not mean that you are cured of HIV. There are three cases where the HIV viral load can come back and be detectable again. The most common cases are the so-called Viral blips. Blips are when HIV levels become slightly detectable, but at a very low level, and then become undetectable again. People may have viral signs when taking their HIV medications every day.
Very rare errorsViral blips are usually caused by problems in the laboratory, such as a small test error or test conditions in the laboratory. Occasionally, they are due to a slight but true increase in viral load due to stress, such as illness or a vaccine. Viral blips, in which the viral load will soon be undetectable, are considered harmless. There is no appreciable chance that a person with a viral virus will transmit HIV to another person.
If you have Undetectable Viral Load Don't Stop ART (Antiretroviral Therapy)People also become detectable when they stop taking their HIV drugs or take them only partially. It can take anywhere from a week to several weeks after stopping HIV treatment to become detectable again. But people will see the levels of viruses in their bodies rise to detectable levels. The least likely scenario for a person to go from undetectable to detectable today is if the virus in its body becomes resistant to the drugs it is taking. ("Resistant" means that the drugs have stopped working against HIV.)
Viral Blipe is Rare and always calls for a closer lookThis is very rare for people who take their HIV medications every day, because the HIV medications we prescribe today (and at least for the past 10 - 15 years) are very powerful and they control HIV very well if taken properly. Resistance is no longer something that is expected to occur, no matter how long a person is treated, as long as they take the medicine well.
And if I miss a dose, will my viral load become detectable again?If you are undetectable and have recently taken your medication every day, your viral load will likely remain undetectable even if you miss a dose. HIV medications are so good these days that it can take a week or even sometimes up to several weeks or more for people's viral loads to become detectable after stopping medications.
Should a HIV-negative person with an undetectable HIV positive partner take PrEP?People in that situation must make a decision about PrEP after learning about it, think about their own specific situation and find out what they are comfortable with. Consider things like:
- Are you monogamous with your partner?
- Do you know if your partner is monogamous with you?
- Does your partner share your viral load information with you? Or not?
- Do you know if your partner is receiving regular medical care? Or are you not sure about that?
PrEP and Undetectable Viral Load?The more uncertainty there is in answering these questions, the more I would suggest to the person that they consider PrEP. It is a sequence of very ambiguous conditionals:
- If someone is in a monogamous relationship with an HIV positive person;
- and if this person has been taking HIV drugs for at least six months
- And if it's undetectable, I'm not sure of any reason to need PrEP.
Do I still need to use condoms if it is not detectable?Sometimes, there is also a psychological benefit to being on PrEP. This can make people feel they are just adding a second layer of protection, and some people may feel better about taking PrEP for this reason. And the Undetectable Viral Load does not protect against other STDs and hepatitis C, for example. And Hepatitis C, as well as syphilis and gonorrhea, which has become resistant to the overwhelming majority of antibiotics is an STD! I think that this state of viral load should be used in combination with a second form of prevention.
Undetectable Viral Load And Other STDs.For, we know, undetectable viral load is one thing. But what about the other sexually transmitted diseases HIV drugs (antiretrovirals) only prevent the transmission of HIV - they do not prevent other sexually transmitted infections (STDs), whether from you to others, or to others. Condoms are still very useful, especially if you are having sex with multiple partners or in situations where you do not know whether your partner may have a detectable HIV viral load or may have an STI. I recommend that people strongly consider using condoms - but it is often for other STIs or due to an unknown HIV status from their partners.
What does Undetectable equal to Non-transferable (I = I) mean?This campaign promotes important medical information that is important for people living with HIV, but it is also an important concept that reduces HIV stigma in the community. The phrase really encompasses an idea that people living with HIV can be free from the stigma of HIV and can live their lives more fully, with less fear, worry and inhibition. Translated by Cláudio Souza on October 25, 2019 from the original in on 5 July 2018, by Emily land
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