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what's really undetectable?
Aug 25, 2013

hi dr. holodniy,

it used to be that if your viral load was below 50, it was considered undetectable. now we have better tests and i see undetectable as under 20. what's next? under 10 and then 1?

then i also read that even if viral load is undetectable in the blood, it can still be detectable in the semen? so what's undetectable really mean?

Response from Dr. Holodniy

Undetectable has never meant "No virus present". It has always been understood that undetectable was a relative term, given that virus could still be present in circulating blood cells or in other organs, when the tests which measure HIV viral load in blood plasma could not detect any virus being present. We know from natural history and HIV treatment studies that people with undetectable viral load in the blood do better. However, the viral load assays have now pushed the limit of detectability down to lower levels. Unfortunately, the published literature on the risks of disease progression or HIV treatment failure associated with very low, but detectable levels (i.e., 1-49 copies/mL), is conflicting. Some studies indicate there is a greater risk in some people, but not all, and other studies claim there is no increased risk. In addition, we don't know what to do with these new very low detectable numbers, as adding more HIV drugs to the mix doesn't seem to get people to zero. So for now, most experts and treating clinicians are comfortable with the < 50 rule as a guidepost for ongoing treatment success.



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