National Emergency Response Council on HIV/AIDS

VIRAL SUPPRESSION AND WHAT IT MEANS FOR PEOPLE LIVING WITH HIV

5 May 2021

NERCHA Head Office- Of the multiple achievements realised in the ending AIDS agenda, many have been asking if reaching an undetectable viral load means one has conquered the Human Immunodeficiency virus in their body. The answer is a big NO!

This is because achieving a suppressed and undetectable viral load does not mean you have been cured of HIV but only means the virus is no longer active enough to cause harm to your body. Of course, if you take medication correctly, you can get and keep an undetectable viral load. This means the amount of HIV in the blood has been reduced to a very low level. This is called viral suppression and it also means you have effectively reduced the risk of transmitting HIV to an HIV negative partner through sex. There is still no evidence though whether keeping an undetectable viral load prevents HIV transmission through sharing needles, syringes, or other drug injection equipment. But the basic rule is to never share needles, syringes or other drug injection equipment. Use new, clean syringes and injection equipment every time you inject.

Getting and keeping an undetectable viral load is the best thing you can do to stay healthy and protect others.  Which is why it is essential to continue treatment at this very important stage in your life because, stopping treatment at this stage can only mean going from hundred to zero. Your health may actually regress and result in death from AIDS. This means your CD4 count will have been reduced and viral load heightened, exposing you to uncontrollable illnesses. That said, let us answer some of your frequently asked questions about viral load suppression below;

 

After I begin treatment, how long does it take to reach undetectable status

Most people living with HIV who begin taking ART therapy immediately and daily as prescribed, achieve an undetectable viral load within the first six months after beginning treatment. This means that most people will need to be on treatment for 7 to 12 months in order to have a durably undetectable viral load. It is therefore essential to take every pill everyday to maintain undetectable status.

 

 

How often should I be tested to confirm that I am durably undetectable

People living with HIV should talk to their health care providers to determine an appropriate schedule for viral load testing. Viral load should be measured every three to six months.

 

If my viral load is undetectable, can I stop taking antiretroviral therapy

No. Not at all. When treatment is stopped, viral load rebounds and the risk of transmitting HIV to a sexual partner in the absence of other prevention methods returns. Taking ART daily as prescribed to achieve and maintain durably undetectable status stops HIV infection from progressing, helping People Living with HIV (PLHIV) to stay healthy and live longer, while offering the benefit of preventing sexually transmitted infections. In fact, stopping and restarting treatment can cause drug resistance , making that treatment regimen ineffective and limiting future treatment options. Remaining on and adhering to treatment is the key to staying undetectable and stopping the virus from replicating and making more copies of itself. Stopping treatment may take you from undetectable to detectable again.

 

If I have an undetectable viral load, can my partner and I have sex without a condom

Although getting and keeping an undetectable viral load may prevent HIV transmission during sex, it is still important to use additional prevention options. PLHIV 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, such as joining a support group. Pre-exposure prophylaxis (PrEP), in which an HIV-negative person takes ART medication to prevent infection, can be part of the conversation. However, neither HIV treatment nor PrEP prevents other sexually transmitted infections or STIs. Ways to reduce the risk of STIs include having both partners tested for HIV, limiting the number of sexual partners and using condoms. Using condoms can provide added peace of mind. Also consider using additional prevention options if you:

  • Are unsure, for any reason, that you have an undetectable viral load;
  • Have a high viral load
  • Have trouble taking HIV medicine regularly;
  • Missed some doses since your last viral load test; or
  • Have stopped taking HIV medication or may do so in the future.

What if I cannot get an undetectable viral load?

Some people face challenges that make it hard to stick to a treatment plan. A few people cannot get an undetectable viral load even though they take HIV medicine as prescribed. Not everyone will reach the threshold of undetectable and that could be due to several reasons such as a particular HIV strain or if the immune system has been damaged to a severe point. However, by continuing to take treatment, in most cases the virus will still be suppressed to very low levels which would still present as beneficial for your health and greatly reduce the risk of transmission compared to not being on treatment at all. And if your viral load is not undetectable or does not stay undetectable, you can still protect your partner by using other prevention options.

 

Do I still have to disclose my HIV+ status if my viral load is undetectable

Although nobody is obliged to declare or disclose their HIV status prior to sexual intercourse, it still remains the duty of the one who knows that they have a disease or condition that is sexually transmissible, to take reasonable precautions against transmitting the condition to others. If you have a detectable viral load, getting tested and treated for other STIs can help lower your chances of transmitting HIV.

 

What if my treatment is not working?

A change is not unusual because the same treatment does not affect everyone in the same way. Your health care provider may change your prescription.

TAKEAWAY

A low viral load means a person is less likely to transmit HIV but it is important to note that the viral load test only measures the amount of HIV in the blood, therefore an undetectable viral load does not mean HIV isn’t present in the blood. As a result, people living with HIV should always seek medical advice from their healthcare providers in order to better understand viral load and the risks of HIV Transmission.