I have HIV. Can undetectable viral load prevent its spread?

Question

Hello doctor,

I am 33 and recently tested HIV positive, with a CD4 count of 380 and viral load around 18,000 copies/ml. I have been advised to start ART with Dolutegravir and Tenofovir, but I am concerned about possible long-term side effects on the kidneys and liver.

Is this regimen safe for someone with slightly raised creatinine (1.3 mg/dl)?
Also, once viral load becomes undetectable, is there still a risk of transmitting the infection to my partner?
Should I be tested regularly for other infections like TB or hepatitis while on treatment, and how often are CD4 and viral load typically monitored?

Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

From your details mentioned, it seems that you have recently started with antiretroviral medications, around six months ago.

A good part of the antiretroviral treatment initiation in your case was that the immune cells, which are determined by CD4 (cell differentiation 4) cell counts, were quite preserved at the time of treatment initiation.

These were 380 cells. Usually, it takes around 22 to 24 weeks for the immune cells to get stabilized and the HIV (human immunodeficiency virus) viral load to suppress.

Baseline HIV viral load in your case was 18,000 copies. This high viral load will be suppressed by effective antiretroviral therapy.

This HIV viral suppression could come to the level of undetectable by 22 to 24 weeks. The report at the end of six months could be even 'target not detected'.

By that, it means the HIV viral copies were too low to be detected by the viral quantization test. This is the actual aim of antiretroviral treatment.

There can be occasional nausea and vomiting in the initial period. It depends on what antiretroviral treatment approach or medications are being started. There can be renal toxicity with the drugs that you have initiated in the long term.

Ensure regular three to six-month monitoring of renal function tests and drink plenty of fluids (eight to 10 glasses of water) in a day.

An improved CD4 cell count would definitely help to prevent the occurrence of many opportunistic infections.

If any concomitant antacid or multivitamin supplement is required, there should be a minimum gap of four to five hours between the antiretroviral drugs. Strict 100 percent adherence to antiretroviral treatment is required to achieve an effective treatment response.

If you achieve an undetectable HIV viral load. It will be equivalent to the untransmittable risk of transmission by sexual contact to the partner. But, still, effective and consistent use of condoms is required to prevent transmission of other sexually transmitted infections.

Six-month monitoring of CD4 for one year is recommended, and HIV viral load should be initially monitored at six months and further recommended at least annually to determine virological failure, if so or not.

I hope my answer helps you, but please revert if you have any other doubts.

Thank you.