New research suggests health care providers reconsider how they talk to people with HIV about low viral load. They say this could be causing confusion over the message: “Undetectable = Unable to Send.”
They even call it a “harmful medical practice” to tell people specific numbers when their viral copy number is less than 200/ml.
This research open forum infectious disease. Researchers at the University of Miami Miller School of Medicine wrote the paper.
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Their conclusion is based on changes in the sensitivity of tests for measuring viral load. Previously, anything less than 200 copies/ml was “undetectable.” There are no records of people with less than 200 copies/ml transmitting the virus to others.
This resulted in the Undiscoverable=Unable to Send message. People newly diagnosed with HIV are usually given medication and told that if their HIV is no longer detectable, they can no longer transmit the virus. It's reassuring for them and their partners, and helps reduce stigma around HIV.
However, in recent years, viral load tests have become increasingly sensitive. Some can detect viral loads as low as 10 copies/ml.
This is causing confusion.
This study uses the example of a young woman diagnosed with HIV. She was informed that taking the medication would make her “undetectable” and unable to transmit the virus. Her viral load was naturally below the 200 threshold. However, over two years, her results hovered around the 20 copies/ml level.
Despite her doctor's assurances, she “became increasingly frustrated by her inability to achieve 'undetectable' status based on reported test values. She believed she was not contagious.” I was skeptical about ART, was dissatisfied with ART, and was reluctant to engage in sexual relations, which I have avoided since my diagnosis.”
Does talking do more harm than good?
The authors go on to suggest that: [viral loads] Although it seems to be detectable, [less than] 200 copies/mL has not demonstrated significant clinical impact and may cause confusion and mistrust among patients and healthcare providers alike, so reporting these values is a public health concern. We believe that this is a harmful medical practice with the above negative messages. ”
They suggest that providers need to think about how the results will be presented. One option is for her health care provider to clearly write “no risk of sexually transmitted infection” next to her number below 200.
Another option is that a viral load below 200 copies/mL would be automatically reported as “undetectable,” concealing the exact value but potentially allowing the provider to disclose it with further explanation if necessary. There is.”
In any case, health care providers should emphasize that anything less than 200 copies/ml is considered undetectable and the risk of infection is zero. You may also be feeling stressed at the time of your diagnosis. The study suggests that patients are told, “Our treatment goal is to have a VL of less than 200 and a CD4 count of 200 or higher.''
Further research is needed to determine whether a low viral load (0-200) has long-term negative effects. They also call for further research to determine “the value, or harm, of high-precision VL.” [viral load] report. “
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