People taking antiretroviral therapy (ART) for HIV can achieve very low quantities of the virus in their blood, which standard blood tests cannot detect. Doctors describe these individuals as having undetectable HIV or an undetectable viral load.
However, even when a person has undetectable HIV, they will still test positive for HIV. Rather than detecting the virus, HIV antibody tests detect the antibodies that the body produces in response to it.
An undetectable status does not indicate a cure. Although ART prevents the virus from creating copies of itself, the virus remains dormant in the body. However, stopping treatment or missing doses allows the virus to begin multiplying, causing it to become detectable in the blood again.
When a person living with HIV takes their medication daily as prescribed, their viral load drops to undetectable levels
The
Although there is still no cure for HIV, a person can take medications to control it. ART is the recommended treatment for all individuals with HIV, regardless of how long they have had the virus and whether they have any medical conditions.
The advice is for people to start with treatment immediately after diagnosis. Delaying treatment allows the infection to damage a person’s immune system, placing them at higher risk of developing AIDS and increasing the likelihood of disease transmission through sexual contact.
Antiretroviral therapy
In a 2016 study, early ART was associated with a 93% lower risk of the transmission of the infection to a partner compared with delayed treatment.
A person needs to take this medication every day, in the way that the doctor prescribed it. Doing this prevents the HIV infection from progressing and allows the person to live a longer, healthier life. It also minimizes the risk of the virus becoming drug-resistant.
Good medication adherence also prevents the sexual transmission of HIV to other people. Research has shown that when ART suppresses a person’s HIV viral load, the risk of transmitting HIV through condomless sex in couples — both
The various types of approved antiretroviral drugs differ in how they interfere with the virus’s life cycle. Learn more about the types of ART.
Approved medications
Below is a list of HIV drugs that the
- nucleoside reverse transcriptase inhibitors (NRTIs)
- nonnucleoside reverse transcriptase inhibitors (NNRTIs)
- CCR5 antagonists
- protease inhibitors (PIs)
- fusion inhibitors
- CD4 post-attachment inhibitors
- integrase strand transfer inhibitors (INSTIs)
- CYP3A inhibitors
Combination medicines are also available, which include two or more of the above drugs in a single pill. Learn more about different HIV drugs.
People who have never received ART have different options for initial therapy. However, the standard initial therapy includes two NRTIs with an INSTI. Doctors consider several factors before providing a person with a specific regimen.
Examples of factors that doctors consider include:
- the person’s preference
- anticipated adherence
- pretreatment viral load
- whether ART is immediate or delayed
- presence of other infections
- pregnancy or a desire to get pregnant
- any underlying health conditions
There is no risk of HIV transmitting from a person with an undetectable viral load to an HIV-negative partner. However, people who cannot reach an undetectable status or stay undetectable can take other steps to reduce this risk.
Abstaining from sex
Refraining from having sex is 100% effective in stopping HIV transmission, pregnancy, and sexually transmitted infections (STIs). However, this may not be a viable option for many people.
Performing safer sexual activities
Instead of performing anal or vaginal sex, couples may choose sexual activities that carry little to no risk of transmission, such as oral sex. Barrier methods, such as condoms, also help prevent the transmission of HIV and other STIs.
Getting tested
Many people may have HIV and not know it because there may not be any symptoms in the early stage of the infection. People with STIs are
Avoiding breastfeeding
People with HIV should not breastfeed because HIV can transmit to a baby through breast milk. They will also need to give HIV medication to the baby for up to 6 weeks after birth.
Taking HIV prevention medicines
Persons who have partners with HIV or use injected recreational drugs can take pre-exposure prophylaxis (PrEP) to avoid getting HIV. Anyone who suspects that they have had exposure to HIV should take post-exposure prophylaxis (PEP) within 72 hours.
HIV medicines may sometimes cause side effects. These are mostly manageable, but some may be serious. The side effects vary among mediations. However, a person should not start a new treatment or skip, stop, or cut down their current medications unless a doctor advises doing so.
When starting on ART, it is advisable to ask a doctor about the usual side effects and what to do if they occur.
A person already on ART should speak with a doctor if they experience any of the following:
- nausea and vomiting
- stomach pain
- extreme tiredness
- difficulty breathing
- pain, numbness, or tingling in the hands and feet
- arms and legs feeling week
- eyes and skin looking yellow
- loss of appetite
- unusual muscle pain
- rashes
- flu-like symptoms
- changes in the urine
Standard tests that look for HIV in the blood may not pick up undetectable HIV. However, HIV antibody tests may still detect the antibodies that the body makes in response to the viral infection.
Taking ART can suppress the virus in a person’s body and lower their viral load. Although a person with undetectable HIV still has HIV, there is no risk of it transmitting to an HIV-negative partner through sex.
A person must take their ART medication as the doctor prescribed it in order to maintain an undetectable viral load. If they do not, the virus can multiply in the blood and reach detectable levels.