By Catherine Murombedzi

DID you know that when the Human Immuno Virus (HIV) is suppressed effectively it becomes undetectable?
Suppressed virus is not detectable.
We have heard many times of the buzz phrase: ‘Suppressed is undetectable’ and wondered what this means. How does one achieve the undetectable stage?
Effective use of anti-HIV medication, also known as adherence, for over six months is the answer. Getting a viral load test after six months of adherence and efficacious medication shows if medication is working well leading to the HIV virus being undetectable. However, this does not mean one stops taking medication when the virus is suppressed. Anti-HIV medication is taken for life.
Note well there is no cure as yet, only suppression.
When one is on anti-HIV medication and religiously taking it as prescribed with medication working effectively, then one must see an improvement on regaining the lost immunity. The suppressed HIV viral load becomes so small that the standard blood tests can no longer detect it.
Anti-retroviral therapy (ART) thereby reduces morbidity and mortality as one is able to live a healthy normal life. When one is said to lead a normal life, that is in relation to restoration of immunity, one still gets ill like anyone with a full immunity.
Viral load monitoring is carried out routinely to ensure that the virus does not mutate. Mutation of the virus means the medication is not effectively working and it needs to be changed. This is only shown by a viral load test, which is the golden standard to monitor suppression.
Not passable
Addressing a ‘Meaningful Involvement of People living with HIV/AIDS’ forum (MIPA) in Kadoma last year, Dr Owen Mugurungi, the director in the AIDS and TB unit in the Ministry of Health and Child Care urged all attending the forum to get routine viral load testing.
“A suppressed viral load means zero risk of passing on HIV to a partner. It means one has fully gained immunity,” Dr Mugurungi said.
“The WHO set out the 90-90-90 which is a noble programme to ending AIDS by 2030, we are part of this ambitious programme. We have adopted viral load monitoring and are in the process of rolling out and equipping health centres nationally.”
Despite this being the standard way to see effectiveness, the test is expensive, at around US$100 in private laboratories. The Government and partners aim to have all public health centres running the test.
“An ‘undetectable’ diagnosis means that the level of HIV in your body is so low (under 40 copies/ml) that it is non-infectious to other people. You might also hear health workers talking about ‘viral suppression’ (where HIV levels are under 200 copies/ml) — if you have had either of these diagnoses, then there is zero risk of you passing on HIV,” he added.
Protection
Dr Mugurungi, however, urged the use of condoms to guard against other sexually transmitted infections.
“I still urge you to use protection; it guards against other sexually transmitted infections,” he said.
Dr Mugurungi said it took time for the body to adjust to any new medications. Viral loads could fluctuate and here arose the need for constant monitoring.
“You may feel healthy and good, however, that is not an indicator of an undetectable viral load. The standard manner is to have regular viral load tests done,” he said.
“Please remember that even if you have an undetectable viral load, HIV is still present in your body. If you stop taking treatment, then your viral load multiples, it mutates, having a negative impact again on the body making the virus transmittable again.”
One could fail to get a suppressed viral load even when taking medication as prescribed. When this happens, it shows that the medication is not compatible with the patient.
“There are few cases where one adheres to medication and still fails to have a suppressed viral load. Tests are then done to show which tablets are not working and have one changed to effective drugs,” said Dr Mugurungi.
As the world embraces the concept of ‘Ending AIDS by 2030’, the ‘90-90-90’ is an ambitious programme to have 90 percent of any country’s population tested for HIV.
The second 90 means 90 percent of the tested people who need ART receive the required medication.
The last 90 means that the people on medication must record 90 percent viral suppression leading to ending the AIDS epidemic by 2030. (World Health Organisation 2013).
Statistics in Zimbabwe show that in the 15 to 64 years age-group who know their HIV status, 86,8 percent are currently on ART. (NAC 2016)
Shingirayi Matogo, who tested HIV positive in 1986 when it was still considered a death sentence, says staying focused helped her live up to today.
“I tested HIV positive in 1986 after the birth of my last daughter. She was ill and we both tested positive to HIV. I lost her in 2000 before anti-HIV medication (was introduced). Being a mother to other children, I remained focused to see my children grow up. I got ill, very ill at times, I prayed to be there for my children. I was lucky that by December 2003, when ART was first introduced, I was a patient living openly with HIV. I got initiated on the first batch at Harare Central Hospital,” said Matogo.
Adherence
Matogo said adherence has been her cornerstone to long life.
“I am glad to be taking first line medication. First line is what can be equated to paracetamol in the case of painkillers. So in anti-HIV medication, they too have classes. The basic is first line, then comes second line which is used if one fails to get a suppressed viral load on first line or keeps getting ill. Then there is a third line. The second and third line regimens are expensive, so all people on ART are urged to adhere so as to keep the cost minimal,” said Matogo.
Matogo has a suppressed viral load.
Tendai Westerhof, a founder member of the Zimbabwe Chapter of Pan-African Positive Women’s Coalition (PAPWC Zim) has been living with HIV for 16 years and religiously taking ART. She said she is happy to be healthy, beyond diagnosis and undetectable.
“My viral load is undetectable. I take my medication religiously and am happy to remain so through adherence. I urge all people on medication to keep on taking medication. Do not be misled by faith healers that the virus disappears after prayers. The issue is that, with effective treatment, you are undetectable,” said Westerhof.
She further urged everyone to get tested for HIV, as those in need will be initiated on treatment.
“Today, there is test and treat, there is no need to fear that one will fail to be placed on treatment unlike a decade or so ago. If we are to say goodbye to AIDS, then everyone must know his/her HIV status,” said Westerhof.
Zimbabwe needs to uphold prevention as the cornerstone of success. Those on anti-HIV treatment must also strive to get viral load suppression six months after starting medication. This is achieved if medication is working well; the person taking the medication has 100 percent adherence and reports early to the health centre if he/she experiences any side effects or an anomaly in his/her day-to-day living.