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Stop taking medicine (WHAT DOES UNDETECTABLE MEAN,2011)
Jan 4, 2011

Hi Dr, I live with my cousin who is HIV positive. We are just roommates, nothing freaky like that. I'm really concerned about him. He was taking the medicine (multiple pill form) for almost a year and he became undetectable. He has since lost his job and no longer has insurance so he has stopped taking the meds. He tells me that he doesn't have to keep taking them now that he's undetectable and that he will just have to take HIV test every 6 months to see if it shows up. I'm also afraid that he could be having sex again (possible unprotected) cause of being undetectable. What does being undetectable mean? What are the risks for him now that he has stopped taking the meds? I went to the Dr with him when he was first dignosed and they clearly said that he shouldn't not stop once he starts.

Any in site would greatly help.

Response from Dr. Frascino

Hi,

Your cousin is either misinformed or in denial; most likely the latter, as he was clearly advised not to stop antiretroviral therapy (ART) once he started it.

Regarding what undetectable means, perhaps I should back up a bit and explain what a viral load is first. An HIV plasma RNA viral load test measures the activity or amount of HIV in the blood. HIV viral loads can range from very low (less than 25-50 copies per milliliter of blood) to extremely high (millions of copies!) It's generally highest shortly after infection during the acute retroviral syndrome (ARS) period or in very late-stage disease when the immune system has been decimated by the virus. When ART is effective, the HIV plasma viral load is driven down to "undetectable" levels (less than 25-50 copies). However, and very important, having an undetectable viral load does not mean there is no virus present or that a person is no longer able to transmit the virus to others! Undetectable merely means the viral load is too low to be measured by the standard blood tests we use.

I suggest you show this post to your cousin. He should contact his HIV physician specialist without delay. If he can't afford his ART, there are patent-assistance programs that should help him secure his medications without interruption. He also should have routine laboratory studies, including CD4 count and viral load, performed every three to four months.

I hope your cousin wises up before significant and perhaps irreparable damage is done (or one of his sexual contacts).

Dr. Bob



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