From the Guidelines
A zero HIV viral load, also called an undetectable viral load, means that HIV medication has successfully reduced the amount of virus in the blood to levels too low to be detected by standard tests (typically below 20-50 copies/mL). This is the goal of antiretroviral therapy (ART) and represents successful treatment. Patients with an undetectable viral load can live long, healthy lives and cannot sexually transmit the virus to others, a concept known as Undetectable = Untransmittable (U=U) 1. However, it's crucial to continue taking HIV medications exactly as prescribed even with a zero viral load, as the virus still remains in the body in reservoirs. Missing doses can allow the virus to rebound quickly and potentially develop drug resistance.
Some key points to consider when managing a patient with a zero HIV viral load include:
- Regular medical follow-up every 3-6 months is necessary to monitor viral load, CD4 counts, medication side effects, and overall health 1.
- Standard ART regimens typically include a combination of three medications, often formulated as a single daily pill such as Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide), Triumeq (dolutegravir/abacavir/lamivudine), or Dovato (dolutegravir/lamivudine) 1.
- These medications work by preventing the virus from making copies of itself, allowing the immune system to recover.
- The primary goals of antiretroviral therapy are maximal and durable suppression of viral load, restoration and preservation of immunologic function, improvement of quality of life, and reduction of HIV-related morbidity and mortality 1.
- Plasma viremia is a strong prognostic indicator in HIV infection, and reductions in plasma viremia achieved with antiretroviral therapy account for substantial clinical benefits 1.
Overall, achieving and maintaining a zero HIV viral load is a critical component of HIV management, and requires careful monitoring and adherence to antiretroviral therapy.
From the Research
HIV Viral Load Zero
- HIV viral load zero, also known as viral suppression or undetectable viral load, is a state where the amount of HIV in the blood is very low, usually less than 50 copies per milliliter [ 2 ].
- Achieving and maintaining an undetectable viral load is a key goal of HIV treatment, as it can prevent the progression of the disease and reduce the risk of transmission to others [ 2 ].
- Studies have shown that antiretroviral therapy (ART) can suppress HIV viral load to undetectable levels in most people living with HIV [ 3, 4,5 ].
Factors Affecting Viral Load
- The use of ART, particularly single-tablet regimens, has been shown to be effective in achieving and maintaining viral suppression [ 3, 4,5 ].
- Adherence to treatment, as well as the potency of the antiviral regimen, are important factors in achieving and maintaining viral suppression [ 6 ].
- Some studies have suggested that even small reductions in viral load can have clinical benefits, and that the goal of achieving an undetectable viral load may not be necessary for all individuals [ 6 ].
Implications of Viral Suppression
- Viral suppression has been shown to reduce the risk of HIV transmission to others, and is a key component of HIV prevention strategies [ 2 ].
- Achieving and maintaining viral suppression can also improve the quality of life for people living with HIV, by reducing the risk of illness and death [ 2 ].
- The World Health Organization (WHO) recommends that people living with HIV aim to achieve and maintain an undetectable viral load, and provides guidance on the use of ART to achieve this goal [ 2 ].