Leading HIV specialist talks about the state of HIV in the 21st century.
HIV was officially recognized and given the name we call it today over 40 years ago. According to the most recent report from the World Health Organization (WHO), an estimated 42.3 million people have died around the globe because of HIV related illnesses.
Despite that, it isn’t uncommon to encounter individuals in the LGBTQ+ community who can honestly say they don’t know anyone who has been infected. It’s hard to believe a community that lost so many at the height of the AIDS pandemic, regardless of their age, isn’t aware of that history.
It’s unfortunate, but memories of the past are often dimmed by the actual passage of time. Developments in treatment for infection have also changed the reality of what the impact of HIV is now.
Once considered a death sentence, HIV infection almost always led to a full-blown case of AIDS and an eradicated immune system that left a patient incapable of fighting off infections and diseases that would eventually rob them of their lives.
That’s not the case today. With advance prevention medications like PReP the number of infections have dropped dramatically. Antiretroviral therapies exist now that allow people infected to achieve undetectable status. Although they can’t pass the virus along to others, however, that doesn’t mean they’re exactly HIV negative.
Because the fight against HIV isn’t over and individuals are still being infected, it’s important to make sure that our community understands the benefits of medications available in the 21st century, along with the possible drawbacks that can still occur with an HIV positive status.
For answers, we turned to Charlotte-based and exceptionally knowledgeable HIV/AIDS expert, J. Wesley Thompson.
A well known member of the LGBTQ+ community and recognized as an expert in the field of treatment for HIV, Thompson is a clinician emeritus, one of the founders of Amity Medical Group and holds such titles as Master of Health Science (MHS), Physician Assistant-Certified (PA-C), an HIV specialist with credentials from the American Academy of HIV Medicine (AAHIVS) and a Distinguished Fellow of the American Academy of Physician Assistants (DFAAPA).
QNotes: What does positive but undetectable actually mean? Is the virus completely eradicated or does it remain dormant in the body but with an extremely low viral load? If so, how low?
J. Wesley Thompson: HIV positive means a person has been infected with HIV and will always be infected with HIV, but the HIV can be controlled with medication. Undetectable means that the viral HIV count is so low that the machine measuring it cannot find it in a blood sample. While most clinicians and patients are used to hearing an undetectable viral load meaning <20 or <50 on the lab reading; the CDC states that undetectable is <200. If … you are undetectable, then you cannot pass the virus to another person during sex or if you share injection drug items. This is where the phrase U=U – undetectable equals untransmittable came from.
QNotes: Is there a point that medication to keep HIV undetectable theoretically becomes ineffective?
JWT: If a person remains adherent to their medications, in theory, the medications can work for a lifetime. The newer medications are far superior to our early medications in the 1990s and there are few if any side effects for most people.
QNotes: Should people who are positive but undetectable disclose their status before any sexual activity?
JWT: Each state has its own laws and many still consider not telling a partner you are HIV positive as a crime. North Carolina control measures were updated, and as of Jan. 1, 2018, if a person living with HIV is virally suppressed for six months or longer, they do not have to disclose their status to sexual partners or use a condom. If their partner is taking pre-exposure prophylaxis (PrEP), the person does not have to use a condom. In addition, a person living with HIV does not have to use a condom during sex if their sexual partner is also living with HIV.
QNotes: Are there any confirmed cases of transmission of HIV from a positive but undetectable individual to a sexual partner?
JWT: Great question! And the answer is … no. We have no documented cases of an undetectable person transmitting HIV to an intimate partner.
QNotes: Even though an individual is undetectable, is their immune system still compromised and are they at greater risk with any kind of infection?
JWT: Yes. I wish I could say that there are no risks with being HIV positive and undetectable, but there are. HIV hides in what we call the sanctuaries, such as the brain, so there are slight chances of increased risk of some cancers, some brain change functions, and the longer you live with HIV, the higher the risks become. Not all persons with HIV will experience complications, in fact, less than half do. Serious complications are very rare. A person can reduce the chances of complications by choosing a healthy lifestyle, eating well, sleeping well, and exercising.
QNotes: Are there any additional thoughts you wish to share?
JWT: HIV has been in the human population since the late 1880s, starting in Cameroon and eventually spreading due to modern transportation such as trains and planes. We do not have a cure, but many scientists are working on one. My advice is to follow the trinity of pre-exposure prophylaxis (PrEP), treatment and prevention (TasP)(U=U), and post exposure prophylaxis (PEP). Knowledge of these three tools could be our cure to ending the HIV epidemic.
