To What Degree Does "On Meds" = "Undetectable"?

[rawTOP]

Question for those of you who are poz and on meds… How often are you not undetectable? Are poz guys on meds usually undetectable (or close to it)?

I've been thinking about how HIV status will be handled on BBBH.com and I'm thinking I won't offer "undetectable" as an option. Instead, like here, I'll just have "on meds" available. If people want to say more about status they can do it in the text of their profile.

But going a step further I'm going to simplify the search options and let guys search by risk level, not by particular HIV statuses. I'm thinking "low risk" would be the neg guys on PrEP plus the poz guys on meds. But if poz guys on meds often aren't undetectable, then being on meds may not make you low risk.

So talk to me about viral loads while on meds. Are you undetectable (or close to it) most of the time while on meds?

[fillmyholeftl]

I went Meds August 2008. Initial VL >300,000. Been undetectable since 3/2009. But then, I am very compliant & also "clean & sober".

[bearbandit]

What's undetectable? A few years ago it was below 400 or 500. These days, it's below 70, 50, 40 or even 20. It all depends on the lab and the hospital's attitude. At my hospital it used to be below 50 but now it's below 70 because they use a different lab. And since viral load is measured on a logarithmic scale, 500 is only twice the number of viral particles as 50. I can't explain any further: I'm good at arithmetic and lousy at actual maths.

Wise not to offer "undetectable" as an option since it's a moving target. A drop down box giving options <100. <1000, <10000 and so on? Or even just a write-in box? Also remember that newly pozzed guys are liable to have a viral load up in the clouds when they start meds and that VL should drop to "an acceptable level" within a couple of months.

Despite my meds I manage to blip just about every year, but that blip is rarely above the old 400 undetectable level: it usually coincides with autumn and the annual flu inoculation.

Most guys maintain a higher VL in their cum than in their blood, except those of us on integrase inhibitors: these seem to have a greater capacity to imprison HIV in its hiding places, hence my two successive zero VLs (ie no HIV found in blood sample: I don't know of a clinic in the UK that does VL testing on semen, though with straight guys becoming fathers, somewhere must be doing it.

After my partner died and I took a drug holiday I went up to about 65k, which isn't really anything to worry about - mildly infectious is what I'd call it. The important number became my CD4 count which dropped from its zenith of 888 to 200 or so (been lower than that though).

In the UK they're more worried about keeping our viral loads down than they are about our CD4 counts. With today's meds if someone doesn't get below VL 500 within three months, they're on the wrong drugs, is the thinking.

Hope this is of some help

[fillmyholeftl]

Most labs "here" are below 20. I think Quest its still below 40.

[BearOKC69_Poz]

When I was diagnosed my VL was over 2 million, Immediately put on meds on the 1st combination worked for me with no side effects...shortly after and continuing with every test since, I quickly became undetectable (even though the definition kept getting lowered, stayed undetectable)...with my bad numbers lowering and my good numbers rising. Been going on 3 years as undetectable. My HIV Dr told me that it is highly unlikely that I can pass it on to anyone (although there is always a slight chance as counts can peak from time to time and nothing is 100%). She stressed the inportance of not missing a single dose and I haven't.

That said, as others have pointed out the definition of "undetectable" is a variable and just because someone is on meds, it doesn't necessarily mean they are undetectable. Such self labeling should be taken for what it is worth. Just as when someone says they are Neg, even if they tested Neg today, it may or may not be a vailid statement.

[TigerMilner]

I went on meds in July of 2012 just 4 months after being infected. I was undetectable within 30 days (<20) and have been since. I never miss a dose. I do know that if you are not 100% compliant on medications or if you are reinfected with a new strain, your viral load can return. Undetectable is a high maintenance status. It really just boils down to two statuses, poz or neg. Of course poz and on meds is much safer than not on meds and even safer than neg (who doesn't realize he got infected yet). Poz on meds is the new safer sex.

[bearbandit]

True, if you adherence to the meds isn't 95% (the figure my hospital uses) you stand the risk of viral mutation and therefore resistance, but the reinfection thing is so rare: may one person per year globally. The amount of virus in one load is quickly going to be taken out by the virus already there, if you see what I mean. Ten years ago we were seeing reports of guys presenting with virus resistant to drugs x and y: that's happening much more rarely now, largely thanks to the efficiency of the drugs regimes we have now.

I boil it down to the statuses poz and unknown: I don't know what you've been up to in the past few weeks, and even after a retest I don't know what you did on the way home from the clinic.

"Poz on meds is the new safer sex." A brilliant line which I'm going to steal for UK usage! Thank you Tiger - kisses wherever (and I mean wherever) you want 'em...

[rawTOP]

Of course poz and on meds is much safer than not on meds and even safer than neg (who doesn't realize he got infected yet). Poz on meds is the new safer sex.

This is really what I'm getting at with how I'm handling HIV status. I want poz guys (on meds) to be seen as "safe sex" (in a bareback context). But I need to understand what the timing of things are and what the risks are.

VL should drop to "an acceptable level" within a couple of months.

I was undetectable within 30 days (<20) and have been since.

It sounds like I should put a note next to where people fill in their HIV status not to choose "poz, on meds" until a doctor has confirmed that their viral load had dropped.

Despite my meds I manage to blip just about every year, but that blip is rarely above the old 400 undetectable level: it usually coincides with autumn and the annual flu inoculation.

So these blips - would you worry if you came in the ass of a neg bottom during one of those blips?

[bearbandit]

So these blips - would you worry if you came in the ass of a neg bottom during one of those blips?

Frankly, not a lot - remember it's a logarithmic scale so that 400 is only 2x40, and we know that it takes a much heavier viral load to establish an infection than that. The blips are, to me, an early warning system that my current drugs may be failing, or, more likely, that it's the colds and flu season. Since the VL test became available erm... fifteen, twenty years ago(?) even with aids defining illnesses I've never had a viral load that would be a threat to others.

Maybe thee answer is to have a dropdown box asking if your viral load is blow 100, 1k, 10k, 100k, and so on or maybe leave it as a write in.

[rawTOP]

Maybe thee answer is to have a dropdown box asking if your viral load is blow 100, 1k, 10k, 100k, and so on or maybe leave it as a write in.

That would be too much detail. I want the simplified, dumbed-down version.

Interesting that VL is logarithmic. I didn't know that.

[bearbandit]

That would be too much detail. I want the simplified, dumbed-down version.

Fair enough - Who's thinking with their big head at that point anyway?

Interesting that VL is logarithmic. I didn't know that.

Fuck knows - what I do know is that it panics and confuses people and I end up having to put the pieces back together at myHIV. I got as far as doing sums: maths is a closed book to me! I specialise in the emotional stuff and leave the science to other members of myHIV...

[Bttm2bBred]

I will only speak for myself. I'm a poz total bttm that first started meds 3.5 yrs ago. At that point I was on death's door with a very high Vl and a cd4 of 7. Within a 6 wks my VCl was undetectable and my cd4 was on the climb on the truvada/isentress 'cocktail'. Everything was fine until this last summer when I didnt stick with my program, My VL went 23,000 and cd4 was 170. Again after adhereing to my regimen, my VL is again undetectable PART 1

[Bttm2bBred]

PART 2 I get it that no one cares about this boring data, but I do think its important for many guys, for their own self worth/image to have that undetectable status. That doesnt mean that I dont tell any potential partner my HIV status either, I do......just my 2 cents in the forum

[Hotload84]

The doctor said I was 'undetectable' within a couple months of commencing treatment, and remained so ever since - about six years. I think the VA uses the 50 copies threshold, but I could be wrong - I'll ask when at my next appointment.

[valeandude]

As a neg man, I care whether the guy is on meds or not. VL is secondary, and important, but what I've noticed there are a LOT of guys out there who don't understand what undetectable really means nor to they understand the risk factors. I think the low-med-high risk scale is interesting, but might be too vague. For me, if I want to stay neg, I'd want to know a little more detail. That's just my personal perspective, but I also readily acknowledge that most men won't know which questions to ask or what the answers really mean. It's an unfortunate truth.