Question

Should I be worried that my viral load is below 20?

11 November 2022. Related: All topics, CD4 and viral load, HIV transmission, Newly diagnosed.

Hi, I was diagnosed with HIV in August 2022. I started taking ART on August 10, 2022. On November 7, 2022 almost around 3 months I went to check my viral load. Test result says: “Positive. HIV RNA is detected. The quantity of HIV RNA is less than 20 copies”.

Should I be concerned whether my medication is working correctly? Or should I just give it some more time and get my viral load checked again after 3 months? I am aware that usually when the viral load is below 200, it’s undetectable level and according to CDC guidelines you cannot transmit the virus either if the load count is below 200. But I am also aware that modern testing apparatuses are now way more sensitive and can detect even in the 20-50 range.

I’m just getting a little worried constantly thinking about it. Any advice or words will be very appreciated to at least give me some sort of relief, as I’m newly detected and have been living silently with constant trauma since the diagnosis. Thank you.

Answer

Answer: Josh Peasegood

Hi, how are you doing?

I am sorry to hear that you feel that you’re having to live silently. Have you had any support since your diagnosis?

You do not need to be concerned. Your test result is excellent and shows that your medication is working. Getting a number depends on the test facilities available where you are and what you healthcare provider chooses to use. Having a result stating that your viral load is below 20, could mean your viral load is 19. But below 20 it is rare for a test to be able to give an accurate result.

Below 200, knowing your exact viral load is of less benefit. As you have read you are unable pass on HIV through sexual transmission. In this sense any viral load below 200 can be considered ‘undetectable’ as there is no longer a risk of passing on HIV.

Your result is not uncommon after 3 months of treatment. ARVs often suppress viral load to very low numbers within the first month. After 3 most people are below 200/undetectable. HIV is no longer affecting your immune system and your treatment is working well.

Josh.