We’ll keep it simple. The most important thing after a positive HIV diagnosis is to start treatment, right away.
With quality HIV care and consistent medication, you can reliably prevent HIV from progressing into AIDS. Not only that: You can set the foundation for a long, healthy life for you and your sexual partner(s). How? By reaching what we call “undetectable” status. We asked Metro Inclusive Health Medical Director, Dr. Luke Johnsen – AKA Dr. J – to tell us more.
Learn About Getting to "Undetectable" Status
What does "undetectable" or "U=U" really mean?
First, let’s start by defining viral suppression: a process of reducing the amount of HIV in the body through medical treatment. Specifically, someone is considered “virally suppressed” when there are “less than 200 copies of HIV per milliliter of blood” (HIV.gov).
Eventually, when the amount of HIV present is so low that it can’t be detected by testing, you’ve reached an “undetectable viral load” or “undetectable” status. For most HIV tests used clinically today, this means fewer than 50 copies of HIV per milliliter of blood (<50 copies/mL).
“Getting to ‘undetectable’ is one of the main goals of HIV treatment,” said Dr. J, “and it can have significant benefits for your short- and long-term health, as well as helping to prevent transmission.”
If I'm undetectable, can I transmit HIV to a sexual partner?
Here’s some good news! When you have an undetectable viral load, you cannot transmit HIV through sex. You might have heard the phrase “undetectable = untransmittable” or “U = U” in conversations about HIV. This slogan was coined by Prevention Access to raise awareness of this concept.
For additional protection, people who are HIV negative can take PrEP to prevent HIV.
What about HIV transmission via pregnancy or drug use?
Unfortunately, when you’re undetectable it IS still possible to transmit HIV during pregnancy or drug use.
“For people who are or can become pregnant,” Dr. J said, “HIV treatment can significantly reduce the chances of transmission during pregnancy, birth, and breastfeeding. Still, the chances aren’t zero, so you should talk with your prenatal care physician and HIV care provider about pregnancy and HIV.”
Sharing injection drug equipment can pose a risk for HIV transmission, as well. According to HIV.gov, “HIV can survive in a used syringe for up to 42 days, depending on temperature and other factors.” That’s why it’s important to use sterile equipment and properly dispose of used items.
Is “undetectable” the same thing as HIV negative?
Currently, there is no cure for HIV or AIDS. So, being virally suppressed or undetectable doesn’t mean that you’re HIV-negative.
“If you stop treatment when you’ve reached undetectable status, HIV can continue to progress and become detectable and transmissible again,” Dr. J warned. Moreover, missing doses of your medications can lead to complications (check out our answer to “What if I stopped treatment and want to get back on track?” below).
When should I start treatment after an HIV diagnosis?
After an HIV diagnosis, you should talk to a provider about starting treatment as soon as possible. Why? “The effects of HIV build up over time, even if you don’t notice at first,” according do Dr. J. For one thing, your immune system can become weaker as you gradually lose white blood cells known as CD4 cells (or T cells).
Research shows that starting HIV treatment early (with a CD4 count above 500) can lead to 53% reduction in the risk of death or serious illness.
“In the past, it was common to delay treatment until someone was experiencing symptoms of HIV infection,” Dr. J reminisced. “However, modern HIV treatment means starting right away for the best health outcomes.”
How do I reduce my viral load?
First and foremost, the key to viral suppression is consistent treatment (what we in the medical field call adherence). HIV treatment through medication is called antiretroviral therapy (ART). Following your treatment plan and working with your doctor can get you on the path to undetectable status.
How long does it take to get to “undetectable” HIV status?
For most people, reaching undetectable status takes up to 6 months. From there, continued treatment and testing will evaluate whether you can maintain that undetectable viral load for another six months. Doing so means your viral load is “durably” undetectable. “At that point,” says Dr. J, “there is effectively no risk of transmitting HIV to a sexual partner.”
What if I stopped treatment and want to get back on track?
Stopping treatment is not advisable, because it can lead to increased risk of illness and drug resistance. But what if it happens? For example, let’s say you misplaced your Rx while on vacation and couldn’t get a new one filled. Or perhaps in a medical emergency, you were unable to take medicine orally.
For any reason, if you miss multiple doses or stop treatment, contact your provider. They can help you:
- Assess your treatment plan and medications
- Measure your CD4 count
- Discuss adherence strategies
- Link with a Case Manager to provide additional support
“Mistakes or emergencies are part of life,” Dr. J said, “but we want to talk with our patients about proactive ways to stay on track, as well as offering effective routes back to adherence.”
Where can I find an HIV primary care provider near me?
Metro Inclusive Health has supported the health of people living with HIV in Tampa Bay for 30 years. Today, we offer cutting-edge HIV treatment in our region (St. Petersburg, Tampa, Clearwater and New Port Richey) with a streamlined approach that combines primary care and HIV care, together. Learn more about the one provider, one appointment approach to HIV care at METRO.
In summary, high-quality HIV care can help most people living with HIV reach “undetectable” status, which means your viral load is so low it can’t be detected by an HIV test. When you’re undetectable, you can’t transmit HIV via sex, but there is a chance to transmit it during pregnancy or drug use. Getting to undetectable can take up to 6 months for most people. Starting treatment early and sticking to your treatment plan are key! And don’t worry – we’ll be here to help you along the whole way.