UNDETECTABLE VIRAL LOAD [U=U]
An undetectable viral load is when the amount of HIV in a person’s blood (viral load) is no longer able to be detected by a standard viral load test for HIV.
People living with HIV who are on anti-retroviral treatment and maintain an undetectable viral load for at least six months do not sexually transmit HIV.
Research of gay and bisexual men who are living with HIV and have an undetectable viral load, and their HIV-negative partners in the Opposites Attract Study reported no cases of HIV transmission in almost 17,000 reported acts of anal intercourse without a condom.
These results support those of previous studies with similar findings and the Centers for Disease Control and Prevention (CDC) supports the notion that ‘Undetectable equals Untransmittable’ – also known as ‘U=U’.
The U=U message declares that because the HIV transmission risk is negligible (“so small or unimportant as to be not worth considering; insignificant”), PLHIV with a sustained undetectable viral load do not transmit HIV to their sexual partners.
On top of this, top line results of the PARTNER trial showed zero HIV transmissions in 22,000 occasions of sex between gay male couples where the HIV infected partner had an undetectable viral load.
While having an undetectable viral load means there is no risk of transmitting HIV, it will not protect from acquisition or transmission of other STIs like syphilis or gonorrhoea. Because of this, it's a good idea to keep condoms in the mix with casual partners and to have a regular sexual health check-up.
Treatment – or Antiretroviral Therapy (ART) – is the term used for HIV medications. There are six classes of HIV medication each attacking the virus at different stages of its life cycle. HIV medications have improved significantly in recent times both in terms of the extent to which they suppresses the virus, and having fewer side effects.
Getting on treatment early gives you the best change of leading a long and healthy life if you are diagnosed with HIV. The START study shows that getting on treatment as soon as possible after an HIV diagnoses is the best thing you can do for your health, both in the short and long term. The study shows that early treatment reduces your chances of developing serious illnesses, such as and liver disease and cancer by more than 50%.
The more regularly you test, the better the chance that HIV will be detected early soon after infection. This gives you the option of getting on treatment early. Many people are able to achieve an undetectable viral load within six months on treatment. If you can get to and sustain an undetectable viral load, then your chances of passing on HIV through unprotected sex are negligible.
Undetectable – or undetectable viral load – is when the amount of HIV in a person’s body (viral load) is no longer able to be detected by a standard viral load test. A person living with HIV (PLHIV) who is diagnosed, on anti-retroviral treatment (ART) and who achieves and maintains an undetectable viral load (UVL) for at least 6 months has effectively no risk of sexually transmitting the virus to an HIV-negative partner.
However, the risk of other STIs remains.
Treatment as prevention (TasP) refers to the use of HIV medication to reduce the risk of HIV transmission at a community level. If everyone living with HIV was diagnosed, started treatment immediately and was able to maintain an undetectable viral load, there would be very little sexual transmission of HIV. In this way treatment would become a form of prevention.
Most people see a significant drop in viral load within 3 to 6 months of being on treatment. A person living with HIV (PLHIV) who is diagnosed, on anti-retroviral treatment (ART) and who achieves and maintains an undetectable viral load (UVL) for at least 6 months has effectively no risk of sexually transmitting the virus to an HIV-negative partner.
It’s important to remember that the risk of passing on the virus is very high when it first enters the body. That’s because HIV replicates rapidly before the body starts to fight it. If you think there's a chance you may have HIV, you need to get tested immediately.
It will be possible for most people diagnosed with HIV to reach an undetectable viral load within 3 to 6 months of starting treatment. However, if someone starts treatment very late and therefore has a low CD4 count, or they don’t take their pills as prescribed, then it will make reaching undetectable more difficult. It is important not to assume that everyone who is living with HIV will be able to reach or sustain an undetectable viral load.
Based on the findings of new research into HIV transmission – including the PARTNER and Opposites Attract studies – we can now confidently say that if someone is able to obtain and maintain an undetectable viral load for at least 6 months, then there is effectively no risk of passing on HIV through sex.
When used consistently and correctly condoms provide the most effective barrier against HIV and many other STIs. Relying on an undetectable viral load to reduce the risk of HIV requires frequent viral load testing and open communication about any changes in viral load and a lot of trust. Until there is transparent communication about viral load testing established with this partner, it’s important to keep the rubbers on.
No. Viral load can go up and down, small blips are not uncommon even if you are taking your medication as prescribed. Regular monitoring of your HIV viral load is an important part of your treatment regimen.
Being undetectable does not protect you or your partner(s) from other STIs and there is evidence that if an HIV-negative person has an STI they are at higher risk of getting HIV. There is also evidence that STIs can increase the viral load of someone living with HIV who is not on treatment.
However, the presence of an STI does not increase the possibility of transmission if the HIV-positive person is on effective antiretroviral therapy.
Definitely not. Remaining on treatment is key to keeping your viral load under control and stopping the HIV virus from replicating. If you stop taking your medication even for a week or two, you give HIV the opportunity to replicate more quickly, increasing your viral load and the risk of developing resistance to your treatment.
By far the majority of people need HIV medication to get their viral load down and keep it there. A very small percentage of people living HIV have successfully managed their viral load without medication. This group, referred to as ‘elite controllers’, are estimated to make up less than half of 1% of all people living with HIV.
There are a range of treatment options, so if you are experiencing issues it is very likely that there will be another treatment that is better for you. This is something you will want to discuss with your HIV specialist. Always keep in mind that not adhering to your treatment carries the risk of developing resistance to certain HIV drugs – meaning your treatment options may be reduced. Any changes to medication need to be managed carefully under the guidance of your specialist.
Fucking without a condom always carries the risk of STIs, particularly if you are having sex with other guys as well as your regular partner. There is a small risk that when two positive guys fuck without a condom that one or both of them will develop a strain of HIV that is resistant to medication. This might happen if one partner has a strain of HIV that is resistant to the treatment that the other guy is on. Transmission of the resistant strain is most likely during a blip in viral load – when one partner may pass the strain onto the other.
Getting to undetectable might not be possible for everyone who is diagnosed with HIV, even if they take their medication as prescribed. It is important that people living with HIV are not pressured or expected to have an undetectable viral load.
Everyone responds uniquely to treatment. If you have been on treatment for 6 months or more, and you are taking your medication as prescribed, you have a good chance of significantly reducing your viral load. However, the exact amount of time it takes to get to undetectable will be different for everyone. Not everyone will be able to obtain an undetectable viral load.
This is something you should discuss with your doctor. A basic guide to viral load testing is to have it done every 3 to 6 months. If, however, you are relying on being undetectable as your primary means of HIV prevention, you may want to consider testing your viral load more frequently. To find out more about this talk to your HIV specialist.
New Zealand law requires people living with HIV to take ‘reasonable precautions’ to avoid passing on HIV. The only case to ever come before the courts in New Zealand was for vaginal intercourse. It found that condoms needed to be used as a precaution. That means that legally, if you are not using condoms during penetrative sex, you must disclose your HIV status. There has not been a case in New Zealand to test whether an undetectable viral load would be considered ‘reasonable precaution’.
Treatments for HIV these days are far less toxic than they once were and side effects much less of a concern. There are some side effects associated with treatment that will be experienced differently by different people. Managing any side effects that do arise is something your HIV specialist will help you with. The research now shows that the benefits of being on treatment, and preferably as early as possible, far outweigh any issues related to toxicity. If you are worried about this, talk to your HIV specialist or contact one of our counsellors here.
Recreational drugs can have a detrimental effect on your health, and therefore work against your efforts to get to, or stay at an undetectable level. There is also evidence of some drug interactions with HIV medications. For example, amphetamines (such as crystal meth) can be present at 3 to 22 times their normal levels in the bloodstream when mixed with an HIV protease inhibitor drug called ritonavir (Norvir). That's because ritonavir acts as a booster and slows the breakdown of your HIV medication so that it lasts longer, but it can have the same effect on any other drugs you might take.
Drugs can also affect your memory, making it more likely that you might forget to take your medication at the right time. If you know you’re going to be partying, plan ahead and carry your treatment on you. Set alarms on your phone or use the app to remind you when it’s time to take your meds. Consider talking to your HIV specialist as they might advise further precautions.
Yes. Unlike many medications, HIV medications do not interact negatively with alcohol.
PrEP and PEP are both HIV medications taken by people who do not have HIV.
PrEP (Pre-Exposure Prophylaxis) is an HIV medication taken to reduce their risk of acquiring HIV. PrEP is currently available in New Zealand through our subsidised pharmaceuticals scheme, meaning eligible people can access it for less than $2 per month. Find out more about PrEP here.
PEP (Post-Exposure Prophylaxis) is a medication given to people who may have been exposed to HIV. Although PEP is not foolproof, if taken within 72 hours of being exposed to HIV, it is likely to reduce the chances of contracting HIV. For PEP to be most effective, it needs to be taken as soon as possible after an episode of unprotected anal sex. Learn more about PEP here.
CD4 or T-helper cells are a type of white blood cell that play a vital role in keeping your immune system working well. HIV attacks and invades these cells so that they are no longer able to do their job of fighting infection. If your CD4 count gets very low, you will be at risk of serious health complications and AIDS.
A viral load count is a measure of the number of HIV particles in your blood at a given point in time. A CD4 count is a measure of the number of CD4 cells in the blood. HIV attacks these cells so they are no longer able to do their job fighting infection. The fewer CD4 cells a person has, the more susceptible they become to a wide range of infections.
Antiretroviral Therapy uses three different types of drugs to fight HIV – targeting the virus at different stages of its life cycle. The risk of developing resistance to treatment is low as long as you are adherent and do not have a strain of HIV that is resistant to the treatment that you are on.
Resistance to treatment most often arises when the level of HIV treatment in your blood is not high enough to fully suppress the virus. This can happen if medication is not taken as prescribed resulting in a spike in viral load. When this happens, newly replicated viruses that have genes that make them resistant to treatment are selected to survive and continue to replicate.
Another way of developing resistance is if you have unprotected sex or share needles with another person who has a resistant strain of HIV and is not undetectable. The strain of HIV that they have would have to be resistant to the treatment that you are on for it to be able to replicate in your body, even if you are taking your medication as prescribed.