HIV Viral Load

What is HIV viral load?

HIV viral load is the amount of human immunodeficiency virus (HIV) present in your blood that tests can detect. Healthcare providers use a blood test to monitor your viral load and determine how well antiretroviral therapy (ART) is working.

HIV is a lifelong viral infection that weakens your immune system and reduces your body’s ability to fight infections. A high HIV viral load means the virus is present and usually making more copies of itself in your body. A low viral load means a minimal amount of virus is circulating in your bloodstream. The goal of antiretroviral medications is to make the virus undetectable with currently available tests.

What are viral load counts used for?

If you have HIV, healthcare providers use viral loads to:

• Monitor how well antiretroviral therapy is working.
• Help your provider make treatment decisions, like adjusting your medications.
• Diagnose babies born to people with HIV.
• Confirm an early HIV infection.
• Monitor how well you’re able to take medications as recommended.

Usually, providers use other types of tests to diagnose HIV. But your provider may diagnose HIV through a viral load test if you recently:

• Had a high-risk exposure to HIV.
• Had a possible exposure to HIV and you have symptoms of an HIV infection.

When are viral load tests performed?

Your provider will test your viral load when you’re first diagnosed with HIV. They’ll also use your HIV viral load levels, along with CD4 counts, to monitor your response to treatment. These counts can tell your provider how well your medications are working and whether your treatment plan needs to be adjusted.

You’ll have a viral load test two to three months after starting ART medications, and you’ll have to repeat the test every three to six months after that. Over time, your provider might adjust that schedule based on your situation.

How does an HIV viral load test work?

A lab technician tests a sample of your blood to determine your HIV viral load. Nucleic acid amplification tests (NAAT) allow them to detect the amount of HIV genetic material (its RNA, or instructions for making more copies of itself) in your blood. Think of NAATs as a magnifying glass that makes viruses more visible — they can detect even small amounts of HIV.

How do I prepare for a viral load test?

You don’t need to do anything to prepare for a viral load test. You can eat and take medications as you usually would.

What should I expect during a viral load test?

A provider will use a small needle to take a sample of your blood from your arm. You might feel pain or discomfort briefly when the provider inserts and removes the needle. The provider will send the sample to a lab to perform the test.

What are the risks of an HIV viral load test?

There are minimal risks of a viral load test. Sometimes, a provider might need to stick your skin with the needle multiple times to find a vein, which can feel unpleasant. Blood draws also carry slight risks of:

• Feeling lightheaded or fainting.
• A large bruise or blood collecting under your skin (hematoma).
• Infection.
• Excessive bleeding.

What kind of results do you get from a viral load test?

Providers report viral load as the number of copies of HIV RNA per milliliter of blood plasma (or about 20 drops of the liquid part of your blood). This is usually written with the number followed by “copies/mL” or “units/mL.”

Results range anywhere from less than 20 copies/mL to over 100,000 copies/mL. But the absolute numbers aren’t as important as your results over time. If your viral load is going down, your ART medications are working. If your viral load is going up, your provider may need to adjust your medications.

You may also receive a negative result, which means tests couldn’t detect HIV RNA.

What is a normal viral load for HIV?

There’s no set “normal” HIV viral load. It’s important that your numbers get lower over time. Ideally, your viral load will reach undetectable levels (below 20 to 50 copies/mL, depending on the lab).

Undetectable doesn’t mean that you’re cured — you’ll still test positive on other HIV tests. HIV can stay inactive in your cells and reactivate if you stop taking ART medications. Being undetectable or having a low viral load means that your ART medications are working well. As long as HIV stays undetectable in your blood and ART continues to work, you can’t spread HIV through sex.

What does a viral load of 200 mean?

A viral load below 200 is called viral suppression — a very low amount of HIV in your blood. Studies suggest you can’t transmit HIV through sex if your viral load is consistently below 200 copies/mL. Previously, HIV was considered undetectable under 200 copies/mL. More recently, tests have been able to detect HIV levels much lower — with these tests, HIV is considered undetectable at 20 to 50 copies/mL.

When should I know the results?

Ask your provider when to expect the results of your viral load test and how you’ll get them. It often takes a week or two to get results.

When should I call my doctor?

Contact your provider if you have any questions about the results of your test. Go to the ER if you have signs of infection, including pain, swelling, pus or fever.

Do I need PrEP if my partner is undetectable?

It’s safest to take pre-exposure prophylaxis (PrEP) if you don’t have HIV and your partner does. This is especially true if their viral load is sometimes detectable or if they sometimes miss doses of ART medications.

But if they have consistently undetectable levels of HIV and are able to take ART medications as prescribed and without missing doses, you might feel comfortable not taking PrEP. Your partner will need to continue to take ART medications consistently and get their viral load tested regularly. Ask your providers for further guidance to reduce the risk of transmitting HIV.