Can You Have Undetectable Viral Load Without Treatment?

Medically Reviewed on 5/25/2022
asymptomatic and undetectible HIV viral load
All clinical criteria state that even if you have less than 50 copies of viral load, it does not mean you are HIV-free.

Although it is not commonly seen, it is possible to have an undetectable human immunodeficiency virus (HIV) load without treatment.

  • Long-term nonprogressors are able to maintain low viral loads (the quantity of HIV in a blood sample) and near-normal T cell counts without the use of medication.
  • An even lower percentage of the population, known as elite controllers, had undetectable viral loads less than 50 copies/mL and normal T cell numbers without treatment for years.

How can you test positive for HIV if you are undetectable?

Undetectable viral load is not the same as not detected. Undetected means the viral load is very low to be detected in the test, whereas not detected means the viral load is zero or negative, which is below the undetectable limit.

Even if your viral load is undetectable, you can still test positive for the human immunodeficiency virus (HIV).

  • If you have a suppressed viral load, you still have HIV antibodies produced by the immune system as a response to HIV infection that gives a positive HIV test result.
  • Undetectable viral load means the virus is dormant inside a small number of cells called viral reservoirs in the body. Even if the virus is undetected, HIV antibodies can still be detected.

Usually, when treatment is interrupted by skipping doses, taking a treatment break, or discontinuing treatment, the virus resurfaces and continues to replicate, becoming detectable in the blood once more. This newly replicating virus is contagious. To attain and maintain a permanently undetectable condition, it is crucial to take every tablet as advised on a daily basis.

According to HIV treatment guidelines in the United States, viral load should be evaluated every three to four months. People with HIV should consult their healthcare providers to identify an appropriate testing plan for viral load.

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Testing positive of HIV with nucleic acid test

In addition to antibody testing, human immunodeficiency virus (HIV) tests identify viral RNA. The RNA need not be active or living. Its viral genetic components are enough for testing. These tests are known as nucleic acid tests, and they can detect HIV infections at an early stage.

  • RNA testing is not usually done as a screening test, but it is done to confirm an HIV-positive diagnosis following a positive antibody test or to determine if a person is responding well to treatment.
  • Some of these viral detection assays may identify viruses at extremely low levels. 
  • Some HIV RNA assays for study (dubbed ultrasensitive testing) may detect HIV RNA levels as low as a single copy level.

According to research, undetectable means a viral load of fewer than 200 copies/mL. Even if your viral load is less than 50 or 20 copies/mL, viral RNA will be identified with one of these viral detection assays.

Detecting a very little quantity of virus on one of these tests indicates that you have not been treated. However, based on the current understanding, it has little practical therapeutic relevance while you are on successful medication. All clinical criteria state that even if you have less than 50 copies of viral load, it does not mean you are HIV-free.

Is being undetectable for viral load a good sign?

If your viral load is undetectable, it suggests you have less human immunodeficiency virus (HIV) in your body. Because the virus is undetectable, it causes less harm to your immune system. This enables individuals to live healthier and longer lives.

The term undetectable does not imply cured. An undetectable viral load indicates that there are few copies of the virus in the blood that current monitoring methods cannot identify. If you are tested positive for HIV earlier, you are still positive for HIV even if your viral load is undetectable. Hence, you should continue to take HIV drugs even if you are undetectable.

Medically Reviewed on 5/25/2022
References
Image Source: iStock Image

10 Things to Know About HIV Suppression: https://www.niaid.nih.gov/diseases-conditions/10-things-know-about-hiv-suppression

Fact Sheet: Undetectable Viral Load: https://www.sfaf.org/collections/beta/fact-sheet-undetectable-viral-load/