HIV Testing: Can Viral Load Become Undetectable?

HIV screening issues

Hello Dr.
Hong, I am the one who mentioned having a positive PCR test at 50 days and a positive fourth-generation ELISA test at 56 days.
You mentioned that the viral load could indeed decrease because the body has immune responses.
I have another question: if I am infected, is it possible for the viral load to drop to undetectable levels after 50 days without treatment, or would the viral load decrease but still remain above the detection threshold of the PCR test (possibly around 50 or 40 copies)?

cc, 20~29 year old female. Ask Date: 2022/08/11

Dr. Hong Yuanbin reply Internal Medicine

Hello, ELISA primarily detects antibodies, so there is no issue of decreased levels.
Although the viral load may decrease in the PCR part, it can still be detected.
Thank you for your question.

Reply Date: 2022/08/11

More Info

Understanding HIV testing and the implications of viral load is crucial for anyone concerned about their health status, especially after potential exposure to the virus. When discussing whether viral load can become undetectable, it is essential to understand the dynamics of HIV infection, the immune response, and the testing methods available.

Firstly, it is important to clarify what is meant by "viral load." Viral load refers to the amount of HIV present in the blood, measured in copies of the virus per milliliter of blood. In the early stages of HIV infection, the viral load can be very high, but as the body begins to mount an immune response, the viral load may decrease. This reduction can occur naturally over time, but it is not guaranteed that it will drop to undetectable levels without treatment.

In your case, you mentioned undergoing a PCR test at 50 days post-exposure and an ELISA test at 56 days. PCR (Polymerase Chain Reaction) tests are highly sensitive and can detect the virus itself, while ELISA tests detect antibodies produced in response to the virus. Typically, during the acute phase of HIV infection, the viral load is high, and antibodies may not yet be detectable, leading to a potential "window period" where tests may yield false negatives.

Regarding your question about whether the viral load can drop to undetectable levels without treatment: it is theoretically possible for the viral load to decrease significantly due to the immune response, but this does not mean it will necessarily drop below the detection threshold of the PCR test. The detection threshold for most PCR tests is around 20 to 40 copies of HIV RNA per milliliter of blood. If your viral load is above this threshold, it will still be detectable, even if it has decreased from its peak.

Moreover, the immune system's ability to control the virus varies significantly among individuals. Some may experience a natural decline in viral load, while others may not. Without antiretroviral therapy (ART), the virus typically remains in the body and can rebound, leading to increased viral load over time. Therefore, while it is possible for an untreated individual to have a low viral load, it is less common for it to become completely undetectable.

In conclusion, if you are concerned about potential HIV infection, it is crucial to follow up with healthcare providers for further testing and guidance. The combination of tests you have undergone is a good start, but if there are ongoing concerns or symptoms, additional testing may be warranted. Regular monitoring and testing are essential, especially if there are any risk factors for HIV. If you have further questions or need clarification on your results, do not hesitate to reach out to a healthcare professional who can provide personalized advice based on your specific situation.

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