Will having low levels of HIV affect your long-term health?

HIV can seriously affect your long-term health. But there are a lot of nuances to how this can happen.

A patient’s viral load is intimately connected to how HIV may affect them later in life.

Let’s get into it.

HIV can be easily managed with the right treatment and medication. Know your sexual health status with a comprehensive HIV test.

Can you have more or less HIV?

If you get HIV, you’ll have it for life. But the degree to which HIV can spread to other people and affect your health will depend on your viral load.

In a nutshell, your viral load is determined by how much HIV you have in your blood. Without treatment, your levels of the virus in your blood will increase over time, raising the likelihood of passing on the infection, as well as negative health outcomes.

But this isn’t the case for most people. The vast majority of people living with HIV in the UK are taking antiretroviral therapy (ART), which significantly reduces their viral load.

HIV treatment has become so effective in recent years that many people on ART will have undetectable levels.

What does “undetectable” mean?

Having an undetectable viral load means the level of HIV in your blood is under a certain threshold that’s not detectable on standard tests. This is usually defined as having fewer than 20 to 50 copies of HIV per millilitre of blood.

Having and maintaining an undetectable viral load helps protect your immune system from the damage that HIV causes. If you have an undetectable viral load, you also can’t transmit the infection to someone else. Most people can reach an undetectable viral load after receiving treatment for six months.

It’s very important that people who are on ART continue taking their medication. Missed doses can lead to an increased viral load.

What if my viral load is detectable but still low?

Not everyone will achieve an undetectable viral load. In a small number of cases, people infected with HIV that still take ART will have a detectable viral load. This condition is called low level viraemia (LLV).

What constitutes LLV is still up for debate, and set levels vary from country to country. They can vary from 51 to 999 copies per millilitre of blood. It’s important to note that viral loads can sometimes temporarily rise on their own, and this isn’t necessarily an indication of treatment failure.  

LLV is unlikely to be caused by nonadherence to ART. It’s more likely to be caused by other factors. Having LLV also won’t increase the likelihood of sexual transmission. Studies have revealed that maintaining a viral load below 1,000 copies per millilitre of blood reduces risk of transmission to near zero.

What are the risks of having long-term LLV?

Having LLV, while certainly better than having untreated HIV, can still come with some undesirable health issues.

Virologic failure

If you have HIV and have been getting ART for more than six months, and your viral load remains over 200 copies per millilitre, you will have virologic failure. This condition can be a significant concern for people trying to manage their HIV since it can indicate the risk of disease progression.

Having LLV doesn’t always result in virologic failure, though. Treatments developed after 2012 have shown to be protective, as well as regimens based on integrase inhibitors.

Non-AIDS related conditions

LLV is associated in some studies with a 31% increase in the risk of a serious non-AIDS events, compared to remaining virally suppressed. Virologic failure raises the risk of a serious non-AIDS event by 75%.

Some health conditions associated with LLV include:

• Chronic kidney disease
• Heart disease
• Prostate cancer
• Anal cancer
• Deep vein thrombosis (DVT)
• Liver cirrhosis

We don’t know why this happens. One theory postulates that having persistent low level viraemia consistently activates the immune system, which can damage your body over time. More research is need in this area to find the true cause. However, more recent studies have suggested that these links may not be as strong as previously thought.

How do I find out my viral load?

Viral load can be detectable within a few weeks after the initial infection. You can get a viral load test to determine how much HIV you have in your blood. If you’re getting treated for HIV, you should be getting regular viral load tests to monitor your condition.  

Final thoughts

Before you can determine your viral load, you need to know your sexual health status. If you’re concerned about a recent sexual encounter, you can get tested at a sexual health clinic near you. Click the button below to book your appointment today.

Don’t leave your sexual health to chance.

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