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Understanding HIV-Related Lab Tests II: Viral Load, Resistance and Tropism

October 26, 2015

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Table of Contents

Lab Tests Are Important Tools

Having regular lab tests is a necessary part of caring for your health. If you are living with HIV (HIV+), lab tests are especially important tools that help you and your health care provider keep track of how you are doing in the following areas:

Immune System Status

Overall Health

HIV Illness

  • How HIV is responding to the drugs you are taking
  • Which drugs to use
  • The specific characteristics of your virus

    • Examples of lab tests: viral load test, resistance test, tropism test (explained below)

Viral Load Test

Viral load is the amount (number of copies) of HIV in your bloodstream. There are several different types of lab tests that measure viral load. All these tests are accurate, but each has a different way to measure the amount of virus. It is best to stick with the same kind of test and not switch among them or it will be difficult to compare results over time.

Viral load results are reported as copies of HIV in one milliliter of blood. The lower the number, the less virus there is in your blood. Numbers can range from about one million copies to as few as 50 copies. If you have fewer than 50 copies, your health care provider may tell you that your results are "undetectable."

Being undetectable is a great result because it means your virus is under control. However, undetectable does not mean that you have been cured of HIV or that you cannot pass it to others. The good news is that studies have shown that having an undetectable viral load can greatly reduce the changes of passing HIV on to others (e.g., being virally suppressed can decrease HIV transmission by 93 percent or more).

Having an undetectable viral load means that there is not enough HIV in your bloodstream for the test to measure. It is also important to know that labs that test viral load have different cut-offs below which they cannot detect HIV. For example: you could have 35 copies of HIV in your blood, and in lab #1, which cannot detect any HIV below 50 copies, your viral load would be considered 'undetectable.' However, in lab #2, which cannot detect any HIV below 20 copies, your viral load would be considered detectable and would report that you have a viral load of 35.

Viral load tests are an important tool to:

  • Check HIV progression
    When compared over time, viral load results show if the amount of HIV in your bloodstream is higher or lower than it was before. The higher your viral load, the greater the chances that your immune system is being damaged.
  • Measure how well HIV drugs are working
    HIV drugs work by preventing the virus from making copies of itself (reproducing). When a combination of HIV drugs (your drug regimen) is working, the viral load usually goes down within weeks of starting the drugs. If your viral load goes up while taking HIV drugs, your drugs may not be working as well as they should.

One goal of HIV treatment is to keep viral load levels as low as possible for as long as possible. This gives you the best chance of staying healthy. With effective HIV treatment regimens, viral load can be reduced to undetectable in many people. This is a great result. It means that your HIV drugs are working and you are doing a great job taking them. However, HIV is still in your body, hiding in an inactive state and not reproducing. If you stop taking your HIV drugs, the virus usually comes out of hiding and starts reproducing; then your viral load will go up.

When Should You Get a Viral Load Test?

  • If you are not on HIV treatment, have a viral load test

    • When you start receiving HIV care

      • Repeat test every three to six months
  • When you start treatment, have a viral load test

    • When starting and two to eight weeks after treatment was started

      • Repeat test every one to two months until viral load becomes undetectable
  • Once you are on a stable treatment regimen and undetectable, have a viral load test

    • Every three to six months
  • When you change treatment, have a viral load test

    • When changing and two to eight weeks after treatment was changed

      • Repeat test every one to two months until viral load becomes undetectable

If your drug regimen is working, your viral load should become undetectable within six months of starting treatment. If this does not happen, if your viral load stays detectable on stable therapy, or if your viral load keeps increasing, it can signal that your drug regimen is not controlling HIV as well as it should. It is important that you and your health care provider discuss all possible reasons (e.g., problems with your body's ability to absorb the drug, problems sticking to your regimen or drug resistance) and take steps to correct the problem. These steps may include additional testing and changing your HIV drugs.

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Understanding Lab Tests I: Complete Blood Count and Blood Chemistry
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This article was provided by The Well Project. Visit The Well Project's Web site to learn more about their resources and initiatives for women living with HIV. The Well Project shares its content with to ensure all people have access to the highest quality treatment information available. The Well Project receives no advertising revenue from or the advertisers on this site. No advertiser on this site has any editorial input into The Well Project's content.

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