1. What is a CD4 count? How important is it to know your count?
CD4 cells are white blood cells that help your immune system fight infections. The HIV virus infects and kills CD4 cells. When their “count” goes too low (CD4 < 200), your immunity becomes weak, and you can get very sick from other “opportunistic” infections, which leads to AIDS and death.
If you take your ARVs regularly, HIV can’t destroy your CD4 cells, and your CD4 count should improve. However, it is completely normal for a CD4 count to fluctuate widely between about 500-1500 from one week to the next, even if your HIV is well controlled. Therefore, even if the CD4 count is good to know, it is not that important to us as long as your viral load is undetectable.
2. What is a viral load? When is it “undetectable”?
The HIV viral load (VL) is the amount of viruses in every millilitre of your blood. The more viruses there are, the more they can keep on infecting CD4 cells, multiplying in them, and killing them. They can also cause damage to many other body tissues, including the brain and kidneys, amongst others.
If you take your ARVs daily, the virus gets killed before it can infect and damage your CD4 cells further. Within a few weeks, the VL can go down to almost zero. Our laboratory instruments are very sensitive, but usually can’t detect any HIV if the VL is less than about 40 – therefore we say your viral load is “undetectable”. On the right ARVs, your VL will remain < 40.
3. Can I infect my HIV-negative partner if we don’t use condoms?
If your VL is undetectable, it’s basically impossible for you to infect your HIV-negative partner with HIV, regardless of whether you use condoms or not. This has been proven time and again by multiple large scientific studies in “serodisconcordant” couples (one partner with HIV and one without) over many years – if the partner with HIV’s viral load is < 40, zero transmissions between the partners have been recorded.
NB: This means that “Undetectable = Untransmissable”, or “U = U”, (both in serodisconcordant men who have sex with men, or heterosexual couples).
Of course, using condoms is still an important way to prevent unwanted pregnancies, and protect against other sexually-transmitted infections.
4. How do I prevent my unborn baby from getting HIV from me?
If your HIV is well-controlled (VL < 40), your baby shouldn’t get HIV from you while growing in the uterus. At birth, the risk of some of your blood mixing with your baby’s blood is slightly lower with a caesarian section than with normal delivery, therefore caesarian section is usually recommended for new mothers with HIV. It is recommended to bottle feed instead of breastfeed, because of the small risk of HIV transmission by breast milk. Your baby will also receive preventative ARVs for the first few weeks of life, just to be safe.
5. What’s the difference between ARVs and PrEP?
People living with HIV (PLHIV) need to take three different types of antiretroviral drugs to keep their HIV under control. Those three drugs are usually combined in a single tablet. Many different combinations are available, and many different trade names exist for similar combinations.
PrEP stands for “pre-exposure prophylaxis”. It’s a combination of two antiretroviral drugs in a single pill, which can be taken by HIV negative persons to prevent contracting HIV from their sexual partner. This could be useful in serodisconcordant couples where the partner with HIV may not be well-controlled on their ARVs, or in people with sexual partners whose HIV status may be unknown.
6. When will new treatments be available for HIV?
Injectable ARVs may become available within a few years. This will require an intramuscular injection only once every two months, without needing to take daily pills. Further on into the future it may also become possible to get implantable ARVs once a year, if ongoing scientific trials are successful.
7. Can HIV be cured?
Currently there is no viable cure for HIV. Since the start of the HIV pandemic in the 1980s, only two people had so far been documented to be cured, but they also had different types of blood cancer, which required bone marrow transplants. This is an extremely risky procedure with a ±50% mortality. It is only done for specific blood cancers if the right donor can be found, and it’s much too dangerous to be a routine option to “cure” HIV. Researchers are still trying to try find a definitive cure for HIV, and over the past few years there have been a few interesting developments, especially in the field of genetic medicine. Vaccine trials are also continuing.