HIV Suppression: Separating Fact From Fiction

If you’re confused about HIV and what viral suppression means, you’re not alone. The National Institute of Health’s National Institute of Allergy and Infectious Diseases (NIAID) recently published a blog post entitled “10 Things to Know About HIV Suppression,” which offers a wealth of information for physicians and patients alike. Among the highlights:

*Viral suppression means the disease is undetectable thanks to ever more advanced antiretroviral (ART) drug treatment. Although HIV doesn’t disappear from the body, the levels of the virus fall so low that blood tests cannot detect them.

*It doesn’t take long to achieve viral suppression. Within 1 to 6 months of beginning treatment, a patient’s viral load will drop below detectable levels, according to the blog. Anthony Fauci, MD, director of the NIAID, asserted that this time frame is fairly conservative; with new medication, people can achieve viral suppression very rapidly.

*Achieving durable viral suppression means there is basically no risk of transmitting the virus to a partner. After the viral load has been undetectable for 6 months, a patient is considered to have achieved durable viral suppression. “This means that most people will need to be on treatment for 7 to 12 months to have a durably undetectable viral load,” the blog authors wrote, taking into account the initial period of treatment during which the viral load drops.

Three large studies recently were completed involving thousands of serodiscordant homosexual and heterosexual couples. In these couples, one partner had HIV and was virally suppressed while the other partner was free of HIV. The couples in all the studies had a collective total of more than 74,000 sessions of vaginal or anal intercourse without condoms, and not a single instance of the HIV transmission occurred.

“We know from a lot of experience now that if you are undetectable, then you really are untransmittable,” Dr. Fauci told Contagion^®. A viral load of less than 40 copies/ml generally is considered undetectable, although Dr. Fauci said this number is not set in stone and could be slightly higher.

*Maintaining viral suppression is a lifelong endeavor. Regular testing is essential if you want to ensure continued viral suppression. Get your blood checked roughly every 3 to 6 months, and make sure there are no gaps in your daily treatment regimen.

“When therapy is stopped, viral load rebounds, and the risk of transmitting HIV to a sexual partner in the absence of other prevention methods returns,” according to the blog post. NIAID conducted a clinical trial in 2006 which demonstrated that subjects who took their medication sporadically had twice the risk of disease progression than those who took their medication exactly as prescribed. Not only do viral levels rise as soon as a patient stops treatment, but the on-and-off nature of intermittent treatment means drug resistance may develop and cause problems down the line.

*Some suppressed patients will experience viral load “blips.” A viral load blip occurs when a person has a brief rise in viral levels. According to Dr. Fauci, a true blip is meaningless. “A blip of going from [40] to 75 [or] 100 is almost irrelevant and nonsignificant,” he told Contagion^®. “The chances of that person infecting [someone] are almost the same as [if they had] no detectable virus.”

It’s important to distinguish between a blip, which may raise viral levels by a trivial amount for a few hours or a day, and something more. “If you go up to [a viral level] of several thousand for a week, that’s not really a blip,” Dr. Fauci cautioned, defining that scenario as more of a rebound. “When someone rebounds, they generally don’t come back down spontaneously.” A person with HIV may see his levels rebound if he stops taking his medication or if he develops a resistance to treatment.

*Being virally suppressed does not protect you from transmitting or receiving other infections and diseases. Viral suppression does not lower your risk of transmitting or contracting hepatitis B, human papillomavirus, and other sexually transmitted infections and diseases. Patients should be encouraged to speak with their health care provider about receiving vaccines to prevent these conditions, and consider using condoms if they have any doubts about potential partners.

Laurie Saloman, MS, is a health writer with more than 20 years of experience working for both consumer- and physician-focused publications. She is a graduate of Brandeis University and the Medill School of Journalism at Northwestern University. She lives in New Jersey with her family.