First identified in 1983 by virologist Luc Montagnier and his team in Paris, HIV used to be a fatal infection until the development and advancement of antiretroviral therapy (ART) can turn the condition into a manageable chronic condition. This virus attacks CD4 cells which are white blood cells assisting the body to battle infections. Nowadays, similar to other people suffering from chronic diseases such as diabetes, HIV-positive people can still lead full and satisfying lives by consuming antiretroviral drugs and objective of achieving an Undetectable HIV viral load
Antiretroviral drugs work by reducing the number of viruses (viral load) in the blood. When taken as prescribed, ART can suppress the virus amount so that it becomes undetectable. It is proven that not only does taking ART prevent the disease’s progression to AIDS and conserve the health of HIV-positive people, an undetectable amount of virus also means that HIV-negative sexual partners are protected from HIV transmission. In this article, we are going to discuss some crucial things regarding “Undetectable = Untransmissible” or also referred to as “U=U”.
We briefly mentioned the way antiretroviral drugs work before. ART impedes the virus from replicating or making copies of itself. When HIV-positive people start taking ART, their viral load will begin to decrease. The amount of time needed for the viral load to be undetectable is usually 6 months or less than that. After diligently consuming ART, HIV-positive people are encouraged to get tested every 3 to 4 months to get the latest status of their viral load and whether or not it stays undetectable. There is a term called ‘durably undetectable’, which means that a person is classified as so if their viral load stays undetectable after the first undetectable result. An HIV-positive person is considered ‘undetectable’ if they have less than 50 copies of HIV per milliliter of blood.
Does Being Undetectable Mean You No Longer Have HIV?
Sexually-transmitted diseases are categorized into curable and incurable. Unlike curable STDs such as chlamydia, gonorrhea, syphilis and trichomoniasis which are caused by bacteria or parasites, HIV is a viral infection which is incurable. Other incurable STDs include herpes, hepatitis B and HPV. HIV, however, is treatable through ART. This also means that after being undetectable, people still have the virus in their bodies and it does not go away. The difference is that after taking treatment, the virus stays dormant in a small number of cells also known as ‘viral reservoirs’. It is imperative for an HIV-positive person to still take treatment even after the test result shows ‘undetectable’. Halting treatment and missing doses cause the virus to replicate again, leading to it becoming detectable again. The virus which is detectable in the blood is infectious and sexual partners have the risk to contract the disease.
Being Durably Undetectable Lessens The Risk of HIV Transmission
There is effectively no risk of transmission from an HIV-positive person with undetectable viral load, which is essentially what ‘Undetectable = Untransmittable’ means. HIV-positive people with undetectable HIV levels in their blood cannot pass on the virus to their HIV-negative sexual partners. There was a major scientific trial in 2011 called HPTN 052 proving that undergoing HIV treatment reduces the risk of passing the virus on to a regular heterosexual partner by 96%. The single reason why it was not 100% was because one person participating in the trial acquired HIV. However, this occurred within a few days after their partner began treatment. The program continued over the course of 4 years and at the end of it, not one person with an undetectable viral load transmitted the virus to their partner. Other big trials included PARTNER and PARTNER 2 in which 972 gay couples and 516 heterosexual couples were recruited to take part in the studies. Among all of these couples, one person was infected by HIV and one was not. While the studies lasted, the gay couples performed 77,000 acts of unprotected penetrative sex and the heterosexual couples engaged in 36,000 acts. When the results were out at the end of 2016 and 2018, not a single partner who was HIV-negative had HIV.
What Happens If I Stop Consuming Antiretroviral Drugs?
When an HIV-positive person stops therapy, viral load will start to increase as the virus begins making copies of itself again. That being said, the risk of transmitting HIV to your sexual partner will return. Research conducted by the National Institute of Allergy and Infectious Diseases (NIAID) proved the benefits of continuously undergoing treatment. In 2006, NIAID held a clinical trial called SMART which revealed that people who were taking treatment irregularly experienced a disease progression rate which was two-times faster compared to those who took the treatment continually.
Antiretroviral drugs should be taken daily as prescribed to attain and maintain durable undetectability. Looking how far medical advancements for HIV have been made since the virus was first discovered and identified, it is amazing that what once was a deadly condition has become controllable. Continuing treatment as directed can help people with HIV live longer and stay healthy. It is not encouraged to stop and restart treatment since it may lead to drug resistance. Drug resistance may cause ineffectiveness of treatment and restrict treatment options in the future.
There is a phenomenon called ‘viral load blips’ in which a durably undetectable person who takes antiretroviral drugs diligently as instructed experiences small and momentary increase in viral load. However, this increase will be followed by a decline back to undetectable levels. Experiencing a blip is quite common and does not mean that treatment has failed to curb the virus. To date, scientists are still putting their thinking hats on to figure out why blips happen.
HIV is incurable but it sure is preventable. Several ways to ward off transmission risks is to practice safer sex which includes the use of condoms and other forms of prevention methods for those who are at risk for exposure. Shim Clinic is a STD clinic in Singapore with services like HIV testing, diagnosis and HIV treatment. We also carry HIV prevention methods such as HIV PEP (best taken within 72 hours after exposure) and HIV PrEP.