From the Guidelines
Taking antiretroviral medications (ARVs) for HIV does not make blood tests show negative for HIV, as the virus is well-managed but not eliminated, and standard HIV tests detect antibodies or viral proteins that remain present even with an undetectable viral load. While effective ARV treatment can reduce the virus to undetectable levels in the blood, this is not the same as being HIV-negative [ 1 ]. The goal of antiretroviral therapy is to improve the length and quality of the patient's life by maximal suppression of viral replication to below detectable levels [ 1, 1 ]. However, this reduction cannot always be achieved with a given therapeutic regimen, and frequently regimens must be modified [ 1 ].
Key Considerations
- Standard HIV tests look for antibodies to the virus or viral proteins, which will still be present even if the viral load is suppressed [ 1 ].
- A person on ARVs with an undetectable viral load is still HIV-positive and should continue treatment [ 1 ].
- Some specialized tests might not detect the virus if it's well-controlled, but this doesn't change the person's HIV status [ 1 ].
- Virological failure is defined as a confirmed HIV RNA level above 200 copies/mL on 2 consecutive measurements in an individual receiving ART [ 1 ].
Recommendations for Patients on ARVs
- Patients on ARVs should continue regular medical check-ups and maintain their treatment regimen as prescribed by their healthcare provider to keep the virus suppressed and protect their health [ 1 ].
- It's crucial to understand that "undetectable" means the virus is well-managed, not eliminated [ 1 ].
- Poor adherence is the most likely reason for failure of a PI-based regimen, and therefore continuation of the boosted PI-regimen is recommended initially with adherence support [ 1 ].
From the Research
Antiretroviral Therapy (ART) and HIV Detection
- Antiretroviral therapy (ART) can reduce Human Immunodeficiency Virus (HIV) loads to undetectable levels in infected patients 2, 3, 4, 5, 6
- However, HIV can persist throughout the body in cellular reservoirs, such as resting CD4+ T cells and monocytes/macrophages, even when ART suppresses the virus to undetectable levels in peripheral blood 2, 3, 6
- The persistence of HIV in these reservoirs means that bloodwork may not always show negative results for HIV, even if the patient is taking ART 2, 3, 6
HIV Latency and ART
- HIV latency is a major obstacle in the treatment of HIV-1-infected patients, as it allows the virus to persist in reservoirs even when ART is effective in suppressing replication in peripheral blood 2, 4, 6
- ART can suppress HIV-1 replication in peripheral blood, but the effectiveness of treatment in suppressing replication in lymphoid tissue reservoirs is not always complete 3
- The size of the inducible latent HIV-1 reservoir in aviremic participants on therapy is approximately 70-fold larger than previous estimates 6
Implications for HIV Treatment
- The persistence of HIV in reservoirs, even when ART is effective, means that a cure for HIV is not likely unless latency is addressed and delivery of ART to cellular reservoir sites is improved 2
- Novel therapeutic strategies, such as the use of nanoparticles to improve ART delivery and efficacy, are being explored to fully suppress viral replication in lymphatic tissues 2, 4
- Combining ART with various means of augmenting and/or reconstituting the host's immune system, especially HIV-1-specific immune responses, may be necessary to achieve long-term control of the virus 5