Virally Suppressed and Loving It

I still remember in 2015 when I first learned how effective anti-retroviral medicine (ARVs) is at stopping an HIV infection from developing into AIDS. In fact, even when ARVs are started after AIDS has developed, they have brought many people back from their deathbed. It is well known that ARVs improve overall health and reduce illnesses, but what I came to realize is just how many lives ARVs saves through what’s known as viral suppression. When the first ARVs were invented, they extended a person’s lifespan by a few months or years, but they were not capable of fully suppressing the virus like modern ARVs do. The more I learned about viral suppression, the more eager I was to enroll on ARV therapy (also called ART). In 2015, I went to the Ministry of Health and Wellness to find out if I was eligible to enroll on ART. Since my CD4 count was above 350, I was told I couldn’t start treatment yet. Then something wonderful happened - the government launched the Treat All program in 2016, enabling all of us who are living with HIV to start treatment immediately, regardless of our CD4 count. I enrolled and collected my first prescription in February 2017, full of excitement for how my life would change. My doctor told me that most people become fully virally suppressed within the first six months of starting treatment. Naturally, all I could think during the first couple of months was becoming virally suppressed. The day that I got my first viral load test results, I was overjoyed to find that I already had an undetectable viral load. With that result in hand, I knew that I was fully protected. I also knew that I must strictly adhere to my medication, continue using condoms and live a healthy lifestyle in order to maintain my undetectable viral load. One thing I realized about some people out there is that they don’t understand the meaning of “undetectable viral load.” An undetectable viral load means that so few copies of the virus are present in a blood sample that some laboratory tests are not sensitive enough to detect them. Despite the limitations of the viral load test, having an undetectable viral load does not mean a person is cured. HIV is classified as a persistent infection, meaning the person will always have at least some HIV in their body. Sadly, the rate of new HIV infections is rising amongst young people in Botswana, despite the availability of ART and the high proportion of people on treatment who are virally suppressed. In fact, it is estimated Botswana will record 14,000 new infections this year- that is 38 every day! There is a dangerous belief that having an undetectable viral load means you can get away with stopping or not adhering to your medication. Others falsely believe that their undetectable status means they no longer need to use condoms. It is important that people realize that viral load can and does fluctuate between times when you are not using condoms, or if a sexually transmitted infection like chlamydia or gonorrhea is present, or when ARV doses are missed. During these times, the chances of transmitting the virus become higher. Remember that even if you have an undetectable viral load, HIV is still present in your body. Even a small number of skipped doses can allow your viral load to increase, putting your long-term health at risk and allowing your HIV to be transmitted. The good news is that while your viral load is undetectable, under correct treatment and monitoring pattern, you don’t have to worry about passing HIV to your sexual partner. The international community calls this U=U, which means undetectable equals untransmittable. Being undetectable means that your body is in good health and that your immune system is working well at defending itself from daily germs. Maintaining your treatment and monitoring routine is key to remaining undetectable and ensuring that you stay healthy.