Question About Undetectable

MrAnonymousGuy

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Hi, I just have a question about the status "undetectable" because I still feel like it's a new concept to me.

So I've been tested a handful of times and every result always comes back as "undetectable"

I've seen it being said that undetectable=untransmittable, and that I get.

However I'm curious as to how I'm considered "undetectable?" / how did I get this way?

Thanks in advance.
 

MancmanMatt

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You have become that way because your body and the HIV infection have responded very well to the treatment.

You and the drugs have managed to suppress the amount of the virus in your blood to a level that is so low it's considered undetectable by today's modern standards. That is the test that determines your viral load is incapable of telling you what your viral load actually is. The amount of virus has fallen so low the test cannot detect how much is there with any reliability, if detect it at all. An antibody test will always show you as being positive though.

Basically the viral load test needs a certain amount of virus, per millilitre of blood, to function correctly and once you go below that it stops working with any reliability. This is when you are considered undetectable. As far as I know the number of copies per millilitre varies from place to place, from between like 25-50, depending on how sensitive the machinery used is. Viral loads go up into the millions. You were probably told what your viral load was when you were first diagnosed.
 

MrAnonymousGuy

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You have become that way because your body and the HIV infection have responded very well to the treatment.

You and the drugs have managed to suppress the amount of the virus in your blood to a level that is so low it's considered undetectable by today's modern standards. That is the test that determines your viral load is incapable of telling you what your viral load actually is. The amount of virus has fallen so low the test cannot detect how much is there with any reliability, if detect it at all. An antibody test will always show you as being positive though.

Basically the viral load test needs a certain amount of virus, per millilitre of blood, to function correctly and once you go below that it stops working with any reliability. This is when you are considered undetectable. As far as I know the number of copies per millilitre varies from place to place, from between like 25-50, depending on how sensitive the machinery used is. Viral loads go up into the millions. You were probably told what your viral load was when you were first diagnosed.

Thanks for your reply!

However I'm confused about my status because tbh, I didn't take medication for it though.... I'm not on PreP, so that's why I'm confused how I got undetectable. :/
 

MancmanMatt

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Okay so your reply is a little confusing I'm not sure where to start.

First of all lets start off with PrEP. This is something you take when you are HIV negative to prevent you from catching HIV and it should not be taken if you are HIV positive. If you take PrEP when you are HIV positive it's not enough to completely suppress the infection and there's a strong chance that the HIV inside you will develop immunity/resistance to the drugs in PrEP. Obviously this is a very bad thing.

When you first become infected with HIV your body goes through a process called sero conversion. This is not instant and can take up to several weeks. During this time the HIV virus starts replicating inside of you and causes what's known as an the initial acute HIV infection. Once the numbers of the virus reach a certain level it triggers your body to defend itself with a big immune response. During this time the copies of HIV in your blood are very high, this is when your body develops its own antibodies against HIV and you can become very sick. I say, can become very sick, because how sick varies greatly from person to person. One of my friends almost died and was in hospital for 6 weeks when he was first infected. Other people have no significant symptoms but it's common to have flu/cold-like symptoms and just feel under the weather.

Once the body has fought against HIV in the acute stage it has won that first battle and developed its own antibodies against the virus. This is also when you will now test positive for HIV with most standard testing. You start to feel better and the copies of HIV in your blood falls to very low levels. Low but not undetectable. As time goes on the copies/ml, in your blood, starts to rise and as it rises the number of white blood cells, known as T-cells, start to decrease. As the amount of HIV gets higher and higher you end up with fewer T-cells and when the number of T-cells gets too low your immune system starts to fail and you are said to have AIDS.

As far as I am aware you do not normally become undetectable unless you are on medication. After the acute phase the amount of virus in your system will be low, but not undetectable low.

There is one caveat to this though and that is some rare people are naturally resistant to HIV and end up undetectable without medication. This is very uncommon and if it were the case with you I would have thought the doctors, handling your long term treatment, would have told you this. It's important for you to know, both in terms of what your long term treatment plan might look like, but also so you know what risk you pose to other people. Clearly they didn't do a good job with you as you've been left confused by what's going on.

If you are indeed one of these rare individuals then consider yourself lucky! It doesn't change anything with regards to long term disease management though. You will need to have regular 3-6 month blood tests to monitor your condition. Usually HIV positive people are monitored whilst being on medication. This is to check that the medication is still working (keeping them undetectable) and to make sure the medication isn't destroying their kidneys or, in some instances, their liver.

You will need to be monitored to make sure that you're still controlling the virus levels yourself, and remaining undetectable, but other than that your kidneys and liver get a free ride.

Is it possible the doctors talked to you about this but you missed some of the points because they were bombarding you with so much information? If I were you I would want them to give you clarification, just to make sure you really are controlling the virus naturally, in case the doctor you saw was mistaken or a bit of a quack.

How many times have you had your viral load tested?
 

cdunstan1

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I am also confused. Have you had an HIV antigen/antibody test or a viral load test? You will only have had a viral load test if you have already tested positive for HIV. If you are positive you are not a candidate for PrEP. As stated above it is extremely rare for somebody not on meds to have an undetectable (really below test limit) viral load.

I would also suggest that you not use LPSG as a primary medical resource. I don't know if @MancmanMatt is a medical pro. I have worked with HIV risk reduction and agree what he says but this site is not a replacement for professional medical personnel. There are a lot of HIV resources in Boston.

Before you go down the "undetectable=untransmittable" road figure out your status and take the time to educate yourself on HIV transmission. Until then please use a condom.
 
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MancmanMatt

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Exactly, it's the confusion which is the biggest issue here.

What you're saying here, MrAnon, is that you've been tested for HIV had a positive test result, then had this test result confirmed by a repeated test. Then you've had viral load and CD4 T cell counts done 3-4 times?
 
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winesthel945

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Yes, I'm similarly confused. Is MrAnon HIV Positive? Or has he been tested 3 or 4 times for antibodies and tested negative?

It seems odd to be running a viral load count if the antibody test has been negative. Indeed, most physicians wouldn't order that test, and most insurance companies wouldn't pay for those tests without a positive diagnosis.

If he has tested positive, it would also be surprising that he's getting viral load tests but is not on any treatment, or doesnt' understand what treatment he is or is not taking -- confusing PrEP with treatment.

@MrAnonymousGuy : Have you ever tested HIV positive? If so, what treatment regimen (if any) are you on? If not, then why are you getting viral load tests? Or are you confusing the standard HIV antibody tests with viral load testing?
 

staplenz

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Is this confusion caused be the way some labs report a negative HIV test? The lab that I go to reports a negative result as either “not detected “ or “undetected”. This means that I have remained HIV negative, NOT that I have miraculously become Positive but virus suppressed.
 

ohiorod

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As someone who works full time in the HIV field, I understand the OP’s confusion. It sounds to me like the OP has confused negative and undetectable. Indicating that he is not on PrEP says he is Negative. No health official told him he is undetectable when he is negative.
As appropriately explained, undetectable is a result of an HIV viral load test that is conducted for HIV+ persons only. It is a test used for treatment, not a diagnostic test, except in very rare occasions.
 
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