What does undetectable mean?
Undetectable refers to ‘undetectable viral load’ or ‘UVL’ for short. This term is used by a clinician when a HIV positive person is taking effective treatment, when taking treatment the amount of HIV in their body (known as their viral load) drops to extremely low levels.
The term undetectable is used to describe a person who has a viral load of less than 200 copies/mL.
With more sensitive testing now available in NSW, laboratories are able to detect small amounts of virus for people who have extremely low viral loads, as low as 20 copies/ mL.
If a guy has a suppressed viral load it does not mean he’s cured or free of HIV. It simply means that the treatment has stopped the virus from replicating.
Someone with a suppressed viral load (less than 200 copies/mL) cannot transmit HIV to their sexual partners. Even if condoms aren’t being used.
How effective is treatment and UVL in reducing transmission?
Research has shown that there is no risk of sexual HIV transmission associated with UVL.
Findings from two large-scale international studies called PARTNER and Opposites Attract found zero cases of HIV transmission among an estimated 89,000 acts of condomless sex between gay couples combined.
How long do I need to be on treatment before my viral load becomes undetectable?
Over 90% of people on treatment will have an undetectable viral load within 3 to 6 months of starting treatment, or even earlier for some.
The effectiveness of treatment within that period depends primarily on what your viral load was before you started treatment, your T-cell count, general health and whether you’ve been on treatment previously.
My viral load has changed with the new sensitive viral load testing that has become available, should I be concerned?
New, more sensitive viral load testing has become available in NSW. For some people, they will see a change in their viral load readings from less than 20 copies, to a new number ranging between 20 and 200 copies. More sensitive testing means that NSW laboratories are able to detect small amounts of virus for people who have extremely low viral loads, this however should not be a cause for concern.
If you have a viral load of less than 200 copies/mL, you are still considered undetectable. A person with this level of viral suppression cannot transmit HIV to their partners. For more information, speak to your doctor.
I’ve met a hot guy who is HIV positive and has an undetectable viral load. Do we need to use condoms?
It’s always important to consider using condoms with sexual partners, including casual sex partners and random hook ups. While the viral load may be undetectable, there are other things you may want to think about – the possibility of STI transmission or when his last viral load test was.
It’s smart for both of you to consider and discuss these things so you can get on with having fun.
What if my partner and I are both positive and undetectable? Can we have sex without condoms?
Research indicates that the risk of picking up another strain of HIV is incredibly rare. However you will need to consider the risk of contracting other STIs, in which case condoms should be used.
Does having an STI impact my viral load?
It depends on whether you are on treatment or not. If you aren’t treating HIV, then yes, contracting an STI can cause an increase in viral load. For example, having syphilis can cause a big increase in the viral load, making it more likely for you to pass on the virus. That’s why it is important to get regular sexual health check-ups and to get your viral load tested after you have had an STI. However, for people who are currently on HIV treatment, STIs appear to have no or very little impact on viral load.
If my viral load is undetectable, can I stop taking my meds?
No. Remaining on and adhering to treatment is the key to staying undetectable and stopping the virus from replicating (making more copies of itself) inside your body.
If you stop taking your meds, then HIV will resume its impact on your immune system, your health may deteriorate and your risk of passing on HIV dramatically increases. Further, by not adhering to the treatment regime prescribed by your doctor, it increases the risk of the HIV in your body becoming drug-resistant.
Once the viral load is undetectable, does it stay that way forever?
No. Viral load can fluctuate and small “blips” can occur, but they’re fairly rare. Regular viral load monitoring is recommended because even if you always remember to take your meds, other health issues may have an impact.
If these blips occur, they tend to be at very low level and typically don’t have an impact on your health or the risk of passing on HIV. Check with your doctor to see if the blip is significant to your health or the risk of onward transmission.
How often should I have my viral load tested?
That depends on your circumstances. A basic guide is every three to four months. It is best to speak with your doctor about this in more detail to determine what’s best for you.
Is it possible to become undetectable if I am not on HIV meds?
Only about 1 in 300 people with HIV keep their viral load suppressed without taking medications. Most people have to take HIV meds to control the virus and become undetectable.
What if I can’t get to undetectable?
Not all people will reach the threshold of undetectable and that could be due to several reasons such as the particular HIV strain or if the immune system has been damaged to a severe point.
However by still taking 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 reduces the risk of transmission compared to not being on treatment.
Do I still have to disclose my HIV positive status even if my viral load is undetectable?
In October 2017, changes made to the NSW Public Health Act 2010 outlined that disclosure of HIV is no longer required prior to sexual intercourse.
Instead, the amendments require someone who knows that they have a disease or condition that is sexually transmissible, ie HIV to take reasonable precautions against transmitting the condition to others.
While ‘reasonable precautions’ is not defined by the Act and can be interpreted differently depending on the scenario, it can be assumed that being on treatment and having a UVL constitutes as this.