Which “Undetectable” standard are you going by?

[ErosWired]

If you do a Google search on “HIV” and “Undetectable”, right now you will likely find a mishmash of both governmental and medical official sources that explain that an Undetectable viral load is a value less than 50 copies/ml... or, less than 40 copies/ml... or, less than 20 copies/ml. Depending on the test. 

What’s more, some sources refer to <200 copies as virally suppressed, and indicate that virus is not transmitted when the virus is suppressed.

When I got my first Undetectable result a few years ago, it was with the <50 standard. In January, I got an Undetectable result with the <20 standard (new doctor, different test). Last week, I had a viral load of 38. If I were tested with two of the mainline tests, the <40 and <50 standards, I would have an Undetectable result. Under the test actually used, with its <20 standard, I don’t. So... am I Undetectable or not?

 Until now, I’ve been Undetectable for about 3.75 years and haven’t missed one single daily dose (believe it or not) of ART since I started it in 2014, so that puts me firmly in the “durably Undetectable” category - until now? Or not?

 I realize that an occasional blip in the data is not unexpected, and I had just changed meds, and my CD4 count is now 40 points higher than it’s ever been. So I realize that an upward drift of about 20 copies to a result that still lies within the mean for Undetectable among all currently used tests for viral load should be no cause for concern.

But - by the standard of the test given, it wasn’t Undetectable.

What do you all think? What standard are you tested under now?

[lower_bucks_bottom]

The term "undetectable" is really a misnomer. I get my testing done at Quest and their standard is <20. But if you read the fine print at the bottom of the test it will some times say that something was detected, but was less then the "limit of quantification" (LOQ). So something was detected, it was just too little to be able to "count". My Dr says that there are tests that can quantify down to 1, in which case we would probably all be detectable, they are just to expensive to use for anything  but clinical studies. Since 2012 when I started on meds I have had 2 blips of ~40. In both cases my Dr says to test again in 3 months rather then 6, just to be safe and in both cases it was back below 20.  The Partner study used a count of <200 so anything below that is good enough for me.

[srider]

Nurse here - less than 200 copies is virally suppressed. If someone has a blip in their VL I'm not concerned. I consider less than 200 to be almost synonymous with undetectable.

[wood]

On 8/31/2019 at 7:16 PM, srider said:

Nurse here - less than 200 copies is virally suppressed. If someone has a blip in their VL I'm not concerned. I consider less than 200 to be almost synonymous with undetectable.

Ding ding.  I do work in outreach and prevention, and while the clinic I work at technically considers more than 50 detectable, Even they will tell the patient its statistically insignificant, unless they have had lots of viral load variability. 

Also, IIRC at one point under 1000 was considered undetectable because thats as good as the tests could measure, and as they have became more advanced the number has went lower

[Guest POZitiveBoyZ]

On 8/7/2019 at 11:30 PM, lower_bucks_bottom said:

The term "undetectable" is really a misnomer. I get my testing done at Quest and their standard is <20. But if you read the fine print at the bottom of the test it will some times say that something was detected, but was less then the "limit of quantification" (LOQ). So something was detected, it was just too little to be able to "count". My Dr says that there are tests that can quantify down to 1, in which case we would probably all be detectable, they are just to expensive to use for anything  but clinical studies. Since 2012 when I started on meds I have had 2 blips of ~40. In both cases my Dr says to test again in 3 months rather then 6, just to be safe and in both cases it was back below 20.  The Partner study used a count of <200 so anything below that is good enough for me.

You have misinformation and misinterpretation.  As a person living with HIV for almost 13 years, I can tell you the following.  Modern test systems can determine how many viral particles are contained in human blood with an accuracy of 20. This time.  Two.  All people living with HIV and taking ART medications should know that yes, from time to time, each of us may experience a so-called blip, which means a slight increase in the number of viral particles in the body.  No one can say when this can happen.  And it depends on many factors, such as stress, the common cold, malnutrition, etc.  However, despite the fact that the number of viral particles may increase, this does not mean at all that an HIV-positive person will be able to transmit the virus to a sexual partner in case of unprotected fucking.  I will explain why.  ART medicines not only help reduce the amount of virus in the human body to a level that can be considered an error, but these medicines suppress the ability of the virus to reproduce itself and also create mutations in the virus genome in which the virus loses its ability to become infected.  Thus, if a person regularly and correctly takes ART therapy, then he ceases to be “dangerous” for sexual partners in terms of the spread of the virus and loses the opportunity to infect other people, even in the case of bareback fuck