How Long Should It Take for My HIV Viral Load to Become Undetectable?
No one likes to play the waiting game, especially when it comes to their health. Many people living with HIV just want to be their healthiest self, which often means getting to an undetectable viral load. The time it takes to reach that milestone can vary. 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 viral load.
On May 18, 2015, an anonymous user asked:
Can you tell me what a reasonable amount of time to expect viral load to be undetectable would be? I started with a pretty high viral load (350k) and a low CD4 count (62) but after a year on Stribild my VL count is consistently over 50. (Last result was 75). My doctor said he considers anything under 200 equivalent to undetectable and I shouldn't worry.
Viral loads almost always become undetectable within 6 months -- even faster with integrase inhibitor-based regimens like Stribild, where we often see complete suppression within 2 months. You appear to be one of those people whose viral load does not completely suppress on therapy. We don't know why this occurs, but it's not usually due to ongoing viral replication. We know that because adding medications rarely makes any difference: the viral load remains the same even when you pile on additional drugs. Some experts have suggested that the detectable viral load is the result of release of non-replicating virus from the latent reservoir.
While I wouldn't consider a viral load under 200 to be "undetectable," it's true that the U.S. definition of virologic failure is a confirmed viral load above 200. Based on that definition, you're clearly not failing, and I would agree with your doctor that you shouldn't worry.
How long did it take you to get to undetectable? Did you worry about it? Discuss in the comments below.
Joel Gallant, M.D., M.P.H., is the associate medical director of specialty services at Southwest CARE Center in New Mexico. You can ask him a question directly on his Tumblr page, Ask Dr. Joel.