Once inside the body, HIV gets inside certain types of white blood cell called CD4. These cells are part of the body’s defenses against infection. Without treatment the virus gradually damages the immune system. Eventually people become susceptible to unusual infections that would not normally trouble someone with a healthy immune system. These infections can be very serious and sometimes life-threatening. However with treatment we can prevent and even reverse the damage that HIV causes.
At the moment there is no cure for HIV. Instead, treatment involves taking daily tablet medication called antiretrovirals. These work by stopping the virus from reproducing itself. After starting treatment, the number of HIV virus particles in the bloodstream (the “viral load”) drops down to a very low level. This prevents HIV from causing harm and keeps the immune system healthy.
These days there are many different antiretroviral treatments to choose from. We use a combination of several drugs to treat HIV, but these are often put together into as few as as 3, 2 or even 1 pill per day. Taking the medication each day keeps the virus level low and maintains a healthy immune system. Without it, the virus will eventually come back which means we aim to avoid any breaks in treatment where possible.
People who take effective treatment can expect to live a normal life expectancy, free from complications or infections related to their HIV. It’s recommended people start treatment as soon as they feel ready. The START study showed that people who started treatment sooner had better health outcomes than those who waited. We also know that people on effective HIV treatment cannot pass HIV on to their sexual partners. We are 100% confident that when your viral load is undetectable, there is zero risk of passing HIV to a sexual partner. Nobody in the world has ever caught HIV from someone with an undetectable viral load. This is often called undetectable=untransmittable (or UequalsU).
We use the ‘viral load’ to check the treatment is working. Before starting treatment that number can be anything up to several million copies. Once you start treatment the viral load will decline rapidly until the laboratory cannot detect the virus in the blood any more. We consider anything less than 50 copies per ml to be an undetectable viral load.
Most people who start HIV treatment will have an undetectable viral load within a few months of starting treatment. Keeping the viral load undetectable means taking treatment reliably each day and we do blood tests every 6 months to ensure things remain stable.