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If somebody is undetectable, why are they still contageous?
Sep 15, 2003

Why is it that somebody who is HIV+ and on medication, such that the virus is "undectable", can still transfer the virus? Are the chances of transfering the virus significantly different when somebody is on medication and the virus is "undetectable"?

Response from Dr. Frascino

Hi,

I know this point can be a bit confusing. Let me answer your second question first. Yes, if someone has knocked their viral load down to undetectable levels, then that person is less infectious (i.e. less likely to transmit the virus). Can they still transmit the virus if they are "undetectable?" Absolutely.

"Undetectable" just means the virus level is below the limits of the test we are using. Years ago, we were only able to measure down to 10,000. So "undetectable" at that time would have been anything under 10,000. Then came 400 as a new improved viral load test, -- and now we can measure down to 25 or 50 copies. However, even with "undetectable" (below 25-50 copies), the virus is still present, and still reproducing (replicating), albeit at a much slower rate.

Also, our test looks at blood. Viral replication may be different in the seminal fluid or cervical secretions.

Bottom line: "Undetectable" does not mean "non-transmissible." So safe sex rules continue to apply, even to "undetectables!" Stay well.

Dr. Bob



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