Question
Should I be aiming for a viral load of 0?
5 May 2011. Related: All topics, CD4 and viral load.
My doctor tells me the aim of HIV treatment is to be undetectable which I understand is a viral load of less than 50. Can you then ever get to a case where your viral load is 0? If so, should that ultimately be the aim of your treatment?
Answer
Thank you for your question.
HIV lives inside one of your immune cells, the CD4 T cells. These cells can sleep in reservoirs around the body. HIV treatment only works on active cells and so cannot reach those cells that are ‘resting’ in the reservoir. These cells wake up sporadically and are the reason you always have some virus.
Your viral load is never zero. At very low levels measuring viral load is dependent on the sensitivity of the test itself. Most tests have a cut-off of 50 copies/mL.
In research studies using more sensitive tests, about 50% of peope undetectable to less than 50 are also undetectable on a test sensitive down to less than 5 copies/mL. Many of these people are undetectable on a test sensitive to 1 copy/mL but they with still have virus somewhere,
The genital tract, the brain and CSF, the lymph nodes are other areas where HIV levels can be higher, but these are difficult areas to test.
Viral load below 50 the viral load is probably bliping up and down below 50 or even below 5 rather than being stabilised at a fixed level.
Viral load above 50 appears to be the cut-off value, above which there is a possibility resistance can occur. This is why the aim of less than 50 is set.
Hi Catherine, thanks. please can you check you mean viral load and not CD4 count.
Viral load results are not usually given as very low numbers Any result less than 50 is usually just called undetectable. Sometimes medical databases need a number though, and this might be why 10 was used.
CD4 counts are another common blood test. Results can be any number between 1 and more than 1600. In this case, a result means someone urgently needs to start HIV treatment (ART). If they are already on treatment, it means the meds are no longer working and need to be changed.
My viral load is 10 what does it mean