Connection between Viral Load and Risk of HIV Transmission

Viral load is defined as the number of virions or virus particles in unit millilitre of blood in a person’s body infected with that particular virus. It is an indicator of the amount/load of HIV virus particles in the body of a person infected with HIV and is directly proportional to the risk of transmission of HIV to the seronegative partner during sex.

When one is detected HIV positive, the viral load test is done before initiation of ART (Antiretroviral Therapy) and then at regular intervals; may be 6-monthly or annually, post initiation of ART. The viral load reports obtained after initiation of ART are compared with the viral load report obtained before the initiation of ART to check the progress of the treatment, efficacy of the ART medications, the outcome as well as to determine the risk of transmitting HIV to others.

An increasing viral load may either mean that the patient is not compliant or adherent towards the treatment or the treatment is not as effective as required owing to various factors such a drug refractoriness and thus, needs to be changed.

It also, indicates that the possibility of transmitting the disease to others is optimally high. On the other hand, a decreasing viral load is considered as a good sign and indicates an efficacious management through ART. With regular ART for HIV, the viral load has been found to reduce to a very low level, in about 6 months.

When the viral load or the number of HIV copies in the blood is too low to be detected by the blood test (usually considered to be <50 viral copies/mL varying from machine to machine in different laboratories), it is called an ‘undetectable’ viral load.

Undetectability is a machine criterion which means that the number of viral copies in unit mL of the seropositive person is so low that the machine is unable to detect it. Thus, the limit for undetectable viral load can vary from machine to machine and can be <20 copies/mL or <30 copies/mL or <50 copies/mL of blood. This undetectable viral load denotes that the HIV virus though still present in the body, is too low to cause any damage and the individual though still HIV-positive, can lead a normal, healthy life.

Testing at regular intervals for viral load is essential to determine if the undetectable level is stable and constant or not. A viral load of <1000 copies/mL of blood is considered to be a case of viral suppression in India and indicates a good prognosis while world across, a viral load of <100 copies/mL of blood is considered to be a case of viral suppression. Even if the viral load has not reached the undetectable level of <20 copies/mL or <30 copies/mL or <50 copies/mL; a viral load of less than 200 copies/mL is also, considered a safe level for condom-free sex as there is no risk of transmission of the disease to others.

However, using a condom for every sexual act is always recommended to prevent the spread of other STIs (sexually transmitted infections) like hepatitis B, hepatitis C which just like HIV infection are chronic diseases and require medical mj anagement throughout the lifetime of the infected person.

Can You Have Syphilis and HIV at the same time?

Yes, Syphilis and HIV are both sexually transmitted diseases that can co-exist in an individual. Though Syphilis is a bacterial disease while HIV is a viral one, their mod..es of transmission and risk factors are similar. They both spread through sex with an infected person.

Oral Sex and Sexually Transmitted Infections

Men who have sex with men and people who have sex with multiple partners are at a higher risk for this co-infection.

Contracting Syphilis predisposes one to HIV as the syphilitic sores provide an easy access for HIV. As HIV virus spreads when a person comes in contact with the body fluids of an infected person, an open sore helps the virus enter the body easily. On the other hand, HIV infection can lower one’s immunity which allows easier infection with other STIs.

Having a co-infection of Syphilis and HIV together can also hamper the treatment as Syphilis can increase the viral load of HIV. Also, lowered immunity due to HIV can help Syphilis progression to later stages that may cause complications.

The good news is that Syphilis is curable with antibiotics like penicillin and HIV can easily be controlled with modern anti-viral medicines also called as ART.

For newly detected co-infections with HIV and Syphilis, the usual approach is to start treatment with penicillin injections and follow this up with ART (anti-retroviral therapy)

If detected early, the outcome is very good and results in full cure for syphilis and undetectable viral load for HIV, in due course of time.

To prevent the co-infections like HIV + syphilis, the most effective strategy is to

  • To use condoms
  • To take PrEP meds, after consulting doctor
  • To get tested at regular intervals or when required

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