Can an HIV rapid test become negative after consistent use of Antiretroviral Therapies (ARTs)?

From the Guidelines

No, an HIV rapid test will not become negative after consistent use of Antiretroviral Therapies (ARTs). HIV rapid tests detect antibodies to HIV, not the virus itself, and these antibodies remain in the body even when the virus is well-controlled by medication. Standard HIV antibody tests (including rapid tests) will continue to show positive results for a person living with HIV regardless of how effective their treatment is or how low their viral load becomes. This is because once the body produces antibodies against HIV, they persist throughout life. ARTs like tenofovir/emtricitabine plus dolutegravir can successfully suppress viral replication to undetectable levels in the blood (typically below 20-50 copies/mL), which prevents disease progression and eliminates the risk of sexual transmission (known as "Undetectable = Untransmittable" or U=U) 1. However, to monitor treatment effectiveness, healthcare providers use viral load tests that directly measure HIV RNA in the blood, not antibody tests. It's essential for people living with HIV to understand that while treatment can make the virus undetectable, it doesn't eliminate HIV from the body completely or change their HIV-positive status on antibody-based tests.

Some key points to consider:

• ART is recommended for virtually all HIV-infected individuals, as soon as possible after HIV diagnosis 1.
• An integrase strand transfer inhibitor (InSTI) plus 2 nucleoside reverse transcriptase inhibitors (NRTIs) is generally recommended for initial therapy 1.
• CD4 cell count, HIV RNA level, genotype, and other laboratory tests for general health and co-infections are recommended at specified points before and during ART 1.
• If a regimen switch is indicated, treatment history, tolerability, adherence, and drug resistance history should first be assessed; 2 or 3 active drugs are recommended for a new regimen 1.

In terms of monitoring, HIV RNA testing is used to detect if ART is failing. When HIV RNA level is above 50 copies/mL, repeating measurement of HIV RNA level within 4 weeks and reassessing for medication adherence and tolerability is recommended 1. Virologic failure is defined as HIV RNA level above 200 copies/mL on at least 2 consecutive tests. Regular age- and risk-appropriate screening for STIs, anal or cervical dysplasia, tuberculosis, general health issues, and medication toxicity are also recommended while receiving ART 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

HIV Rapid Test and Antiretroviral Therapies (ARTs)

• The question of whether an HIV rapid test can become negative after consistent use of Antiretroviral Therapies (ARTs) is complex and depends on various factors, including the effectiveness of the ART regimen and the individual's adherence to the treatment 2, 3, 4, 5, 6.

Effectiveness of ART Regimens

• Studies have shown that certain ART regimens, such as those based on dolutegravir (DTG), can be more effective in achieving viral suppression than others, such as those based on efavirenz (EFV) 2, 3, 4, 5.
• For example, a study published in Cureus found that DTG-based regimens achieved higher rates of viral suppression than EFV-based regimens after 12 months of treatment 2.
• Another study published in Einstein found that DTG-based regimens were associated with a shorter time to viral suppression and higher odds of achieving viral suppression than EFV-based regimens 3.

Impact of ART on HIV Rapid Test Results

• While ART can suppress the virus to undetectable levels, it is not clear whether this would result in a negative HIV rapid test result 6.
• HIV rapid tests typically detect the presence of HIV antibodies or antigens, rather than the virus itself, so it is possible that a person on effective ART could still test positive for HIV even if the virus is suppressed 6.

Factors Influencing Viral Suppression

• Adherence to ART is a critical factor in achieving viral suppression, and studies have shown that certain ART regimens may be more "forgiving" of poor adherence than others 6.
• Other factors, such as age, baseline CD4+ T-cell count, and baseline viral load, can also influence the likelihood of achieving viral suppression 5.