What does “Undetectable” really mean?

The term “undetectable viral load” pops up everywhere from lab reports and medical journals to social media sites and dating apps.

Here are some key terms and concepts to help guy living with HIV and HIV-negative folks understand and explore what “undetectable” means.

Key Terms

  • Viral load. Viral load refers to how many copies of HIV are present in a milliliter sample of blood. A viral load test estimates how much HIV is in the blood. It is used to monitor immune function and see how well HIV treatment is working.
  • Antiretroviral therapy (ART). ART involves taking medications to keep the virus from replicating in an HIV-positive person’s cells. Taking ART decreases viral load.
  • Undetectable viral load. When copies of HIV cannot be detected by standard viral load tests, someone living with HIV is said to have an “undetectable viral load.” For most tests used in clinics today, “undetectable” means fewer than 50 copies of HIV per milliliter of blood. Reaching an undetectable viral load is a key goal of ART.
  • PrEP. Short for “pre-exposure prophylaxis,” PrEP is an HIV prevention strategy in which HIV-negative people take an oral pill once a day to reduce their risk of HIV infection.

Being Undetectable: Good News

  • You can live a healthier and longer life. Using ART to reach an undetectable viral load means that there is less HIV in your body. Less HIV means less damage to your immune system, allowing you to stay healthier and live longer.
  • You can reduce HIV transmission risk. Studies have shown that people living with HIV who use ART can reduce the likelihood of transmitting the virus to their HIV-negative partners by as much as 92–96%. More people on effective treatment and with their virus in check means more HIV infections are prevented—an approach called “treatment as prevention,” or TasP.

A Few Words of Caution

  • “Undetectable” does not mean “cured.” An undetectable viral load means that so few copies of the virus are present in the blood that today’s monitoring tests are unable to detect them. Even with an undetectable viral load, however, an HIV-positive person still has the virus.
  • It’s not impossible to transmit HIV. Your viral load can fluctuate between monitoring tests. This can happen for no known reason, or when you have a sexually transmitted infection like chlamydia or gonorrhea, or when ART doses are missed. During these viral load “blips,” the chance of transmitting the virus may be higher. Also, viral load tests only monitor the amount of HIV in the blood, not in semen or vaginal fluid. We do not yet know how much virus needs to be present in body fluids for transmission to be possible.
  • Research has mostly included heterosexual couples. The studies that established ART treatment as effective at reducing HIV transmission by 92-96% focused almost exclusively on heterosexual couples. More research is needed to assess whether suppressed viral load has identical benefits for gay and bisexual men and people who inject drugs.
  • New HIV infections continue to increase among gay and bisexual men. Despite the availability of ART and high levels of viral suppression, HIV incidence (the rate of new infections) is rising among gay and bisexual men, for reasons that researchers are investigating.

While suppressing the virus to undetectable levels has clear benefits for both people living with HIV and HIV-negative people, treatment as prevention is just one strategy for preventing new HIV infections. Other essential tools for HIV prevention include condoms and lube, sterile syringes for people who inject drugs or hormones, PrEP for HIV-negative individuals, regular HIV testing, self-education about HIV and sexual health, and open communication with sex partners.

Check out this short video clip that describes what undetectable means – betablog.org/video-undetectable-viral-load/

This post was written by Emily Claymore, MPH, who served as an intern at San Francisco AIDS Foundation during her time at the University of California, Berkeley.