Q and A

Question

Will someone always test HIV positive – even with an undetectable viral load? – updated answer!

If you have achieved undetectable level and have been so for a period of say 6 months, and then were to have an HIV test at another clinic where they don’t know your positive status, would the test come back as negative because you are undetectable or would it still be reactive?

Answer

For nearly everyone, the HIV tests will still be HIV positive.

This is because HIV tests look for an immune response (called an antibody).

Even if there was an HIV cure – and this might be found one day – your antibody response is always likely to test HIV positive (i.e. be reactive).

Some HIV negative people in early HIV vaccine trials, test HIV positive on an antibody test because of their immune response, even though they do not have HIV infection.

An exceptions if for people who start HIV treatment (ART) within a few weeks or months of their infection. After being on ART for several years, people who used very early treatment, can sometimes test HIV negative with “rapid” HIV tests.

This report includes details of a recent study reporting this:
http://i-base.info/htb/32657

Treating HIV even earlier – within days of infection – means that some HIV positive people never test positive on an HIV antigen test. This is even though viral load (RNA and DNA) has shown they are positive. A study in Bangkok was able to diagnose some gay men in very early infection. Immediate ART meant that many of these people never tested HIV positive – until they had a treatment interruption as part of a cure study.
http://www.croiconference.org/sessions/hiv-rna-rebound-postinterruption-persons-suppressed-fiebig-i-acute-hiv

Cases of sero-reversion (HIV positive people who later test negative) have also been reported for some babies treated immediately after birth.
http://programme.aids2018.org/Abstract/Abstract/12202

This answer was updated in August 2018 and December 2017 from a Q&A first posted in June 2001.

65 comments

  1. Roy Trevelion

    Hi Sakwe,

    As Simon says here, for nearly everyone the HIV tests will still be HIV positive.

    This is because HIV tests look for an immune response (called an antibody).

    But it’s great that your viral load is undetectable.Being undetectable means you cannot tramit HIV even if you don’t use condoms. Please see U=U.

  2. sakwe

    I was tested positive with a cd4 of 567 and after taken ARVs for some months i became undetected. Is it possible that am negative now

  3. Roy Trevelion

    Hi Tony,

    It’s not common, but it could be an exception.

    As Simon says on this Q&A, for nearly everyone, the HIV tests will still be HIV positive. That’s because rapid HIV test looks for an immune response (called an antibody).

    An exception is for people who start HIV treatment (ART) within a few weeks or months of their infection. After being on ART for several years, people who used very early treatment, can sometimes test HIV negative with “rapid” HIV tests.

    Do you have access to your viral load and CD4 test results? You can ask the clinic to check them over the last couple of years. And you can also ask to see these test results when you were first diagnosed.

  4. Tony

    I have been diagnosed as positive and have been on art medications for a couple years now. With that being said I just had a rapid hiv test at another clinic and the results came back negative twice. Is this common?

  5. Lisa Thorley

    Hi Precious,

    An ELISA test is very accurate. Its rare that they are wrong. However, if you think that this may be the case you’ll need to have another test done. If its possible you should ask to have a viral load test done.

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