Just How Many “Undetectables” Are There?

     Get a load of this encouraging new development:  recent research has indicated that the Centers for Disease Control and Prevention (CDC) may have overstated the size of the U.S. HIV population, while significantly underestimating the share that has a fully suppressed viral load (undetectable).  Researchers utilized HIV lab reporting to estimate prevalence of the disease in New York City and 19 other jurisdictions. 

     Next, they used previously published data to construct a revised HIV treatment cascade, or the HIV Care Continuum.  This cascade refers to the descending proportion of individuals living with HIV who have been diagnosed, are retained in medical care, have been prescribed antiretrovirals (ARVs), and are virally suppressed.

     Before going further, let’s fully understand what being undetectable is–and means.  First and most importantly, it does NOT signify that you are cured of the virus.  What it does mean, according to Melissa Dahl’s article entitled, “What Does It Mean to Have ‘Undetectable’ HIV,” is that “the anti-retroviral treatment is working, and that the amount of HIV in the blood is so low that even the best available tests don’t pick it up.  As it is usually defined now, to have an undetectable viral load means that there are fewer than 20 copies of the virus in one milliliter of blood.  Compare that to those who have just been diagnosed and not yet treated, whose tests show millions of copies in the same sample size.”

     Dahl adds, “The very latest research is showing that it is highly unlikely for people with an undetectable viral load to transmit the virus to a sexual partner—even without the use of a condom.”

     Now, back to the care continuum.  In 2011, the CDC estimated that 1.2 million Americans were living with HIV.  Poz.com states, “The U.S. care continuum estimate, which also refers to 2011, has long stated that 86 percent of the American HIV population has been diagnosed, 40 percent is engaged in care, 37 percent has been prescribed ARVs and 30 percent is virally suppressed.  These figures are frequently cited as troublesome barometers of the dismal job the U.S. health care system is doing taking care of HIV-positive individuals.”

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     But as stated in the first paragraph, recent research has indicated that in fact, viral suppression rates have been steadily rising among HIV-infected Americans.  Poz.com continues, “Researchers used 2009-2013 data from the Medical Monitoring Project, covering 23,125 HIV-positive people, to estimate the proportion of those receiving HIV medical care who had a fully suppressed virus.”

     From 2009 to 2013, the portion of individuals who had a fully suppressed virus at their last viral load exam rose, from 72 to 80 percent.  The largest increases were seen among 18-to-29-year-olds, whose viral suppression rate rose from 56 to 68 percent; 30-to-39-year olds (62 to 75 percent); and blacks (64 to 76 percent).

     Poz.com adds, “The researchers in this new study estimated that, in fact, the CDC’s HIV prevalence estimate for 2011 was 25.6 percent too high, that the true number of Americans living with the virus was 819,200—or somewhere between 809,800 and 828,800.”

     Now, thanks to the improving surveillance of CD4 and viral load test results throughout the nation, the CDC can better make more accurate estimates of the number of those who are undetectable.  And, an official revision of the national HIV viral suppression rate should come later this year.

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