Tag Archives: Undetectable

The “Undetectability” Of It All

     For years, I’ve been reporting and writing about HIV/AIDS.  When I’ve asked individuals the question, “Would you be sexually intimate with someone who’s undetectable?,”  I’ve gotten some rather blunt and curt responses.   Here are three:

    “Uh-uh.”

    “But doesn’t pre-cum contain the virus?”

    “Nah…I’ll think I’ll pass!” 

    However, the 44-member AIDS United Public Policy Committee—the largest and longest-running national coalition of community-based HIV/AIDS organizations–strenuously begs to differ.  According to AIDS United, its Public Policy Committee very recently has “strongly affirmed the conclusive evidence proving that people living with HIV who have achieved a sustained, undetectable viral load cannot transmit HIV to sexual partners.  This evidence-based declaration reinforces AIDS United’s programmatic, policy and advocacy work to expand access to antiretroviral medications to all people living with HIV.”

     Before we go any further, let’s clearly and completely understand what it really means to be “undetectable.”   First, it doesn’t mean that the HIV-positive person is cured.  However, it does mean that antiretroviral treatment is being effective, and that the amount of HIV in the blood is so low that even the best available tests don’t detect it.

     To have an undetectable viral load means there are fewer than 20 copies of the virus in one milliliter of blood.  Typically, the tests of those who have just been diagnosed and not having undergone treatment show millions of copies in the exact same sample size.

     Therefore, on March 6, the AIDS United Public Policy Committee released the following statement:  “Substantial evidence strongly demonstrates that a person living with HIV who has a sustained, undetectable viral load cannot sexually transmit HIV to another person.  Continued analysis of large-scale clinical trials has shown zero cases of HIV sexual transmission.  This expands on prior data that the risk of HIV transmission from a person living with HIV who is on antiretroviral therapy and has achieved an undetectable viral load (viral suppression) in their blood for at least 6 months is negligible to non-existent.”

     AIDS United concurs with the stance of the Prevention Access Campaign (PAC), which is “People living with HIV on ART (antiretroviral therapy) with an undetectable viral load in their blood have a negligible risk of sexual transmission of HIV.”  PAC “is a multi-agency health equity initiative to end the dual epidemics of HIV and HIV-related stigma by expanding access to HIV prevention, and empowering people with and vulnerable to HIV with accurate and meaningful information.”

     The AIDS United Public Policy Committee added, “Too many people living with HIV are not getting the message of this benefit of treatment and sustained viral suppression from their clinical providers or the HIV education and advocacy community.  Understanding that maintaining viral suppression through successful antiretroviral therapy not only maintains health but also prevents transmission can encourage people living with HIV to initiate and adhere to treatment regimens and may help reduce HIV-related stigma.  We acknowledge, however, that social and structural barriers exist that prevent some people living with HIV from achieving viral suppression.”

     Sadly, antiquated U.S. HIV laws and policies simply do not reflect the up-to-date science regarding HIV transmission risks.  “Scientific evidence about the reality of transmission risk based in this data about viral suppression and transmission risk has already had an impact on HIV criminalization statutes and prosecutions in Europe,” according to AIDS United.

     The organization, therefore, makes two critical recommendations:

  • That providers and educators consistently share the message that new evidence demonstrates that a person living with HIV who has a sustained, undetectable viral load cannot sexually transmit HIV to another person.
  • That HIV criminal laws and policies in the United States be modernized to reflect the science related to viral suppression and HIV transmission risk.

    Jesse Milan, Jr., AIDS United president and CEO, termed the transmission evidence “a landmark development” that too few of us are hearing about.  “This development puts each one of us living with HIV at the forefront of stopping new infections,” stated Milan, Jr.  “It gives everyone strong, clear and direct language to stop the stigma and move all communities faster towards ending the epidemic.”

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.”

UNDETECTABLE 1

     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.