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May 22, 2006

Hi Dr.Bob,

Could being undetectable mean that if I go to the doc to do a blood test for HIV, and I happen to be undetectable at the time mean that it will read HIV negative? This is a bit worrying. Or will the test still show positive to HIV?

Keep up the good work!

Response from Dr. Frascino



Having an undetectable viral load had testing negative for HIV antibodies are two completely different things. The test to determine whether someone is infected with HIV is called an HIV-antibody test (ELISA or EIA). It measures proteins (antibodies, also called immunoglobulins) in the blood that are made by the immune system as it tries to fight off the virus. Once someone is infected, it takes a number of weeks for the immune system to "kick in" and produce these antibodies (the "window period"). However, following this period, the HIV-infected person will continue to test HIV+.

The viral load test is a direct measurement of how much virus is in your blood. This can be significantly reduced by taking antiretroviral medication (HAART). These potent medications can reduce the level of viral replication (amount of virus) to such a degree that it becomes "undetectable" (or nondetectable) using our current tests. That doesn't mean there isn't any HIV present, but rather that the level of virus in the blood is lower than what we can measure. It's also important to note that HIV infiltrates many other body tissues besides the blood. If an "undetectable" person were to stop his or her HIV meds, their virus would once again begin to rapidly replicate and their viral load would skyrocket.

Bottom line: no one has been cured of HIV disease. Once someone is HIV positive, he or she remains positive for life, no matter what his or her viral load measures.

Hope that helps clarify this issue for you.

Dr. Bob

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