What is viral load suppression?

The goal of ART is viral (load) suppression but this can only happen if a person takes their treatment properly every day. Viral load refers to the amount of HIV there is in the blood. It is measured as copies of the virus per millilitre of blood (copies/mL). Taking ARVs on time, every day makes the viral load drop very quickly. In the first week of treatment it can drop by 90%. Viral load suppression is when the amount of virus in the blood has dropped to less than 50 copies of HIV per milliliter and it cannot be detected by a viral load test. The test result will say it is 'undetectable' If ART is skipped or stopped HIV will take the chance to grow stronger and attack the immune system again. Viral load can increase daily to up to a million copies of virus per drop of blood.

Before starting ART the CD4 count is the best way of telling how healthy the immune system is and how urgently a person needs to start treatment.

A CD4 count

  • Thisblood test measures how many CD4 cells are in the blood.
  • The higher the CD4 count is the stronger the immune system is.
  • Test results are given as cells per cubic millimetre (cells/mm3) of blood.
  • A result of about 500-1,500 is considered normal.
  • Every time the CD4 count drops by 100, the relative risk of acquiring AIDS doubles.
  • If viral load is high- more than 1000 - and CD4 count is low -200 or less - it is very important to start treatment as soon as possible.
  • If a CD4 is below 200 the risk of HIV related illnesses is great. A person may be diagnosed as having AIDS, the final stage of HIV infection.

After starting ART viral load is the best important measure of how well the body is responding to treatment and whether viral suppression has been achieved.

When a person is virally suppressed their CD4 count usually goes up but this is not always the case. CD4 counts are affected by many factors and can change from morning to night. They are affected by other illnesses like herpes or flu. The Viral Load (VL) test is the best way to know how much HIV activity there is in the body and whether the antiretroviral therapy (ART) is working.

If you are virally suppressed does that mean you are cured?

No, there isn't a cure for HIV yet. Viral suppression means that there is such a small amount of HIV in the blood that a viral load test does not pick it up. ART is the best treatment option available if you take it correctly and as the doctor has prescribed. Since the South African government introduced ARVs into its hospitals and clinics, the number of AIDS-related deaths has dropped and fewer people are sick with HIV-related illnesses

A Viral Load (VL) test

  • Measures how much of the HIV virus there is in a drop of blood.
  • Results are given as copies of the virus per millilitre of blood (copies/mL).
  • If there are less than 50 copies of the virus in one millilitre of blood, this will not show up in the blood test. The test results will come back saying the virus is undetectable. This means a person is virally suppressed.

It is more useful to look at the trend over a period of time than to compare two test results. Usually if a person is virally suppressed, their CD4 count will increase but this doesn't always happen. There are other factors that may influence test results. For example

  • An infection like pneumonia may lower a CD4 count but the immune system is weakened by the pneumonia. Sometimes it is better to wait until the immune system gets stronger before being tested.
  • Not sticking strictly to ART will mean that the treatment won't be effective and viral load will increase.

Antiretroviral treatment (ART) reduces the amount of HIV in the body, which results in viral load suppression.If someone is virally suppressed they can enjoy a long and healthy life.

How ARVs suppress HIV

Antiretrovirals, or ARVs, are drugs that suppress or control HIV. ARVs are the only effective way to control HIV infection. There is no cure for HIV. ARVs work by stopping HIV from hijacking the body's CD4 cells to make more HIV. This means that ARVs do two things:

1. They stop HIV from making more copies of itself
2. They stop HIV from destroying CD4 cells (the immune system)

This is why when HIV treatment is taken properly:

Viral Load goes down - the amount of HIV in the blood and body decreases
CD4 Count goes up - the immune system recovers and becomes strong again

To suppress HIV properly, three different ARVs must be taken together as Antiretroviral Treatment (ART). These different drugs put up roadblocks that stop HIV to make sure that it can't hijack CD4 cells. The different ARV drugs stop HIV when:

  • It is entering the CD4 Cell
  • It is inside the CD4 cell
  • It is ready to release the new copies of HIV from the CD4 cell