Question

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

5 September 2018. Related: All topics, CD4 and viral load.

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

Answer: Simon Collins

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 study reporting very early ART and several years of viral suppression can result in testing HIV negative using rapid HIV tests.

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.

Cases of sero-reversion (HIV positive people who later test negative) have also been reported for some babies treated immediately after birth.

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