Becoming undetectable

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07 Jan 2016

When you’re newly diagnosed you’ll hear the term “undetectable” being bandied about. What does it mean and what are the benefits? Christopher Kelly reports.

Whilst the choice of whether you commence treatment upon diagnosis or not is ultimately yours, the benefits of doing so cannot be undersold.

Last year’s START study confirmed emphatically that the sooner a person with HIV initiates treatment the better it is for their overall, long-term health. In fact, the START findings were so conclusive that the World Health Organisation changed its treatment guidelines shortly after their release.

But it’s not only the health of the person living with HIV that is greatly enhanced by early treatment; you also protect the health of others. How so? The sooner you’re on HIV medication — normally, a once-a-day single pill — the sooner you’ll reach an undetectable viral load (the viral load essentially is the amount of HIV in the body). Most people on treatment usually get to undetectable within three to six months.

(It’s important to note that not all people reach an undetectable status — and that’s nothing to be overly concerned about. It just means you have to be that extra bit vigilant about your health and passing the virus on to others.)

Becoming undetectable doesn’t mean that a person is cured of HIV; it means the treatment is working successfully and that the level of the virus in the blood is so low that it can’t be picked up in tests. Clinically speaking, this is defined as having fewer than 20 copies of the virus in one millilitre of blood (to put that into perspective, a person just diagnosed will commonly have millions of copies per millilitre).

Being undetectable makes it highly unlikely that the virus will be passed on to sexual partners. In fact, study after study has shown the chance of onward transmission to be virtually nil. Preliminary findings from an ongoing Australian study, for example — Opposites Attract —monitored gay couples of mixed HIV status (positive-negative) for an average of 12 months. Out of 6,000 acts of condomless anal sex, zero HIV transmissions were recorded. These results echo those of numerous overseas studies.

However, being undetectable doesn’t magically shield you from sexually transmitted infections such as syphilis or gonorrhoea. A person’s viral load will increase a little in the presence of an STI, potentially making a negative partner more susceptible to HIV. The virus can also fluctuate when you’re sick with the flu, for instance, or when there are breaks in treatment. But generally, if you keep in good health and keep up the meds, an undetectable viral load should protect you from opportunistic infections. 

It’s not just your physical health that benefits from obtaining an undetectable HIV status. Anecdotally, it’s also transforming the way positive people feel about themselves. Becoming undetectable often empowers people living with HIV; people say they feel as if they have gained control over the virus by proactively managing their health. They say they feel more relaxed about sex, secure in the knowledge that they are unlikely to pass the virus on.

Becoming undetectable diminishes the Bogey Man that is HIV. It’s a positive affirmation (pun intended) that all is good and that your treatment is working well.

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