Important note: Information in this article was accurate in 2005. The state of the art may have changed since the publication date. Two part question:
First, I was diagnosed HIV positive in early October 2004 with a VL of 93,000 and a CD4 count of 245. I've been on Combivir and Sustiva for 3 months now, and now my HIV levels are undetectable; CD4 is still low at 289, but my Dr. said that the virus is now "suppressed".
1) Am I still contagious?
2) Do I still have to use a condom? I've been married for 15 years, and if my spouse didn't catch it when my VL was 93,000 , what are the "odds" of him catching it now?
Second part, if all these people are getting tested for HIV and they come back negative, does this mean they could still have this virus because it's "undetectable"? An ELISA test isn't given around here unless the first test comes back positive, so what's up? I understand that no Dr. (even you) will give anyone "permission" because of liability suits, saying, yea, it's ok to have unprotected sex when there's still that small chance. How much of a small chance is it?? Undetectable levels means it can't detect the virus when it's under 400 copies, so how many copies do I actually have?? Could it just be 1?? How could I find out??
Sorry for the numerous questions, but this doesn't make any sense!
Please help,
Thanks for your time
When your viral load dropped to undetectable - which is usually less than 50 viral copies by the ultrasensitive method, it simply means that the lab machine just can't discriminate or find the viruses when there are so few left in the blood. But your are still infectious. The virus is still replicating at a very very low level. In fact, you may periodically blip - which means every once in a while your viral load will rise to a detectable level. It may be only 75 or 150, but then the next time if will be undectectable again. You can't predict when this blips may occur. So you still need to use a condom.
However, we do know that when the viral load is undetectable, this is much less risk of transmitting HIV. The risk is never zero, so we do not recommend that you stop using condoms. Yes the odds are in your favor, but the odds are in your favor with Russian roulette, too - just one bullet and five empty chambers.
As far as your spouse not having picked up HIV yet: he may just be lucky The insertive partner has about 10 times less risk of picking up HIV than the receptive partner. And some people have t-cells that have less attachment sites for HIV and therefore are at less risk for picking up HIV. But again, that risk is not zero. So once again, you should still use condoms.
Finally, the ELISA screen for HIV is an antibody test, and it is usually the first test given. If that is positive, then the Wester Blot is the confirmation. Once you pick up HIV, the antibodies are always there, even if the virus is suppressed to undetectable levels.
There is no accurate way to count below 50 copies. There are some labs that will spin down the blood and concentrate it to artificially create viral load readings down to 5. But that has no clinical usefulness, since less than 50 is so darn low already that we know the meds are working as well as they can.
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