An HIV Doctor Tells You if Undetectable Really Is the New Negative

Associate Editor
Joel Gallant, M.D., M.P.H.
Joel Gallant, M.D., M.P.H.

Does being undetectable change the way you talk about your HIV status? Can a person who is undetectable stop worrying about transmitting HIV? Getting to undetectable isn't always easy to do -- and once you're there, it's definitely an accomplishment for your health. But, what exactly does it mean? On his personal Tumblr, Joel Gallant, M.D., M.P.H., an HIV doctor at Southwest CARE Center in Santa Fe, New Mexico, answers questions from people living with HIV who are concerned about a number of issues, including their undetectable viral loads.

On Jan. 17, 2015, an anonymous user asked:

Hello doctor, I read in a previous post that someone says "undetectable is the new negative." Do you agree with this statement at least to some extent?

Dr. Gallant answered:

To some extent. From a transmission point of view, having an undetectable viral load is close to being negative. And from the standpoint of prognosis and life expectancy, people with undetectable viral loads and normal CD4 counts have more in common with HIV-negative people than they have with people with untreated HIV infection.

But there are still important differences between someone with well controlled HIV and someone without HIV -- if there weren't, we wouldn't still be looking for a cure. Even with well controlled HIV, you have a chronic medical condition that is expensive to treat and that causes an increase in chronic inflammation and immune activation. You still have viral DNA integrated into your own genome. I'm not willing to go so far as to say that "undetectable is the new negative," though I understand the sentiment.

How does this make you feel about having an undetectable viral load? If you have any more questions, make sure to visit our Ask the Experts forum on understanding your labs.

Mathew Rodriguez is the community editor for TheBody.com and TheBodyPRO.com.

Follow Mathew on Twitter: @mathewrodriguez.