Suppressing the virus

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02 Mar 2015

Deborah from Wagga Wagga writes:

I’ve just been diagnosed HIV-positive. There’s lots of talk online about achieving an undetectable viral load — what is that and what does it mean?

Dr Louise replies:

A viral load is the number of copies of the HIV virus in the blood plasma of someone living with HIV. An undetectable viral load is reported when the number of copies in the blood is 20 copies/ml or less (<20 copies/ml). Recent research suggests that people living with HIV with undetectable viral loads  are more likely to maintain higher CD4 counts, meaning a more robust immune system. Becoming undetectable also greatly reduces the risk of onward transmission of HIV.

Antiretroviral treatment (ART) is very effective at reducing the production (or replication) of HIV, raising levels of CD4 cells and slowing disease progression. For this to happen, however, it is essential that the HIV medications are taken every day, strictly as prescribed. HIV treatment consists of a combination of at least three drugs taken daily.

Two to four weeks after starting treatment your doctor may order some initial blood tests to check liver and kidney function. A viral load level will be assessed at about six weeks after commencement of treatment. As a guide, the viral load will often drop significantly on the first test; the virus will then, ideally, be fully suppressed — i.e. undetectable — within six months.

Your doctor may  be concerned if there is detectable viral load (>200 copies /ml) on at least two separate occasions four weeks apart, or if there has been failure to suppress the viral load to undetectable by four to six months after initiation of ART. (This rarely happens.)

If, however, the viral load is not decreasing as expected, it may be because the medications haven’t been taken regularly or, in some cases, resistance may be present. To ensure there are no drug interactions that could be interfering with the ART, be sure to tell your doctor if you are on other medications. It’s also important to let your clinicians know if you are having trouble remembering to take your HIV meds or you think you may be experiencing side effects.

With effective treatment, most people living with HIV will experience improved immune function which will lead in many cases to near-normal life expectancy.