What is a viral load? Why is it important to me? What is a bad viral load? What does it all mean?
Viral load is a measure of HIV in the blood. HIV is the “Human Immunodeficiency Virus”, this is the virus that causes the HIV infection. Nucleic acid amplification test (NAAT) tests for viral load, not for the presence of HIV antibodies. HIV viral suppression is important to assure both personal health and public health benefits and this is why it is constantly monitored.
Lower levels of viral load are better than higher levels. Therefore, it is ideal to be “undetectable” or have “viral suppression” which means that there is so little virus in a person who is living with HIV’s blood that it cannot be measured by viral load tests. An undetectable viral load is associated with better long-term health. The person is still HIV positive, but the risk of infection is lower and the chances of passing the virus to a partner is greatly reduced. If a person is not suppressed, has a “detectable viral load”, the person’s immune system will eventually be damaged and the person has a greater chances of becoming sick. For more information about the importance of taking HIV medications every day, see "Why should I take medication? How is it decided what medication to take for the HIV virus?" below.
What is a t-cell count? What is a CD4 level? Why is it important to me? What is a bad CD4 count? What is a good CD4 count? What does it all mean?
T-cells are a class of immune system cells that play a major role in carrying out the activities of the immune system. Some T-cells are called Helper T-cells (or CD4 cells).
A CD4 count is a lab test that measures the number of CD4 T lymphocytes (CD4 cells or CD+ T cells) in a sample of your blood. CD4 cells are white blood cells that fight infection. The more you have, the better. In people living with HIV, it is the most important laboratory indicator of how well your immune system is working and the strongest predictor of HIV progression. The CD4 count is like a snapshot of how well your immune system is functioning. These are the cells that the HIV virus kills. As HIV infection progresses, the number of these cells declines. A normal range for CD4 cells is about 500-1,500. Usually, the CD4 cell count increases when the HIV virus is controlled with effective HIV treatment.
When a person living with HIV has a CD4 count less than 200 cells/mm3 an AIDS diagnosis is made. AIDS is the most advanced phase of infection with HIV (human immunodeficiency virus) in which the immune system is weakened. The person becomes more susceptible to a variety of infections (called opportunistic infections) and other conditions such as cancer. A diagnosis of AIDS is made based on the results of blood tests (see above) or has an AIDS-defining illness. For a list of these illnesses, click here.
How will I pay for my HIV care and medications?
If a person already has health insurance, the insurance will most likely cover the cost of the medications used to treat HIV. Depending on the health care plan, the person may still have co-pays. If a person does not have health insurance, there are options to help provide the medication at no cost or at a reduced cost. The New York State Department of Health, AIDS Institute offers five programs known as the HIV Uninsured Care Programs to provide access to health care for people with (or at risk of) HIV who are uninsured or underinsured:
- ADAP (AIDS Drug Assistance Program) pays for medications used to treat HIV/AIDS 18
- ADAP Plus (Primary Care) pays for medical visits and lab tests at enrolled clinics, hospitals, and private doctors’ offices
- HIV Home Care Program pays for home health care
- APIC (ADAP Plus Insurance Continuation) pays the premium for cost-effective health insurance.
- PrEP-AP (Pre-Exposure Prophylaxis Assistance Program) pays for medical and lab testing associated with the use of Pre-exposure Prophylaxis medications to prevent HIV.
How to apply:
- Phone: 1-800-542-2437 or TDD: 1-518-459-0121. Staff is available to answer your questions. Hablamos español.
Why should I take medication? How is it decided what medication to take for the HIV virus?
People with either HIV or AIDS can lead healthy lives if they receive ART and appropriate routine medical care. HIV is treated by taking a combination of medications. The different medications fight the virus at different stages. The health care provider will use a lab test called a genotype test or resistance test to determine the most effective treatment regimen for the patient. The Genotype Test looks directly at the genetic material of the HIV in your blood and give you information about the HIV drugs your virus is resistant to, they are the most common and widely used resistance test.
The good news is that pharmaceutical companies combine the different antiretroviral medications into one pill. This means that for many patients, treating HIV may be as simple as taking one pill, once a day. It is important to seek treatment for HIV as early as possible. Getting early HIV treatment will help keep people living with HIV healthy and prevent HIV from affecting how long they live or how well they feel. The pills have either no side effects or manageable side effects.
Do I continue to take medication if I feel fine?
Taking the medications consistently is the most important key to staying healthy and feeling well. Once a person begins to feel well, that does not mean they should stop taking their medicine. In order for HIV medication to be the most effective, it should be taken every day even if the person feels healthy. When people living with HIV who see their healthcare provider regularly and take their medication every day, there is a very good chance that they will become virally suppressed. Viral suppression, sometimes known as being undetectable, is an important goal of treatment. Viral suppression means the amount of virus in the person’s blood is below the level the test can identify.
If a person living with HIV doesn’t take their medications regularly, the treatment won’t work as well and the amount of HIV in your body will increase. That is called having a detectable viral load. This will eventually lead to damage to the person’s immune system and greater chances of becoming ill. If people living with HIV don’t take their medication regularly, it also can lead to what is called drug resistance. This means the virus can get around the medication and the healthcare provider may have to prescribe a new treatment plan that might be more complicated to take, or possibly have a greater risk of side effects.
How can I tell my medication is working?
A person can tell if his or her HIV treatment is working by looking at the results of the blood tests that measure viral load and the health of the immune system (CD4 count). An HIV treatment regimen is considered effective if: it’s able to control HIV to the point that the virus is “undetectable”; or the CD4 count is close to or within the normal range. Even when HIV treatment is effective, the virus is still present, but the viral load level is low enough that HIV is considered controlled.
If I miss taking my medication on the time I am supposed to take it, should I double up on taking my next dose? Can I take my medication at any time I remember?
Ideally you should take your medication at the same time every day. If, for some reason, you realize that you have missed a dose, you can go ahead and take your medication as soon as you can that same day, then take the next dose at your usual scheduled time. However, you should never double up on doses when you miss a day of your medications.
Missing doses of HIV medicines can reduce their usefulness and increase the possibility of developing drug resistance, which makes certain HIV drugs lose their effectiveness. If you find you are missing doses of your HIV medications, talk to your provider and pharmacist about ways to help you remember to take the medications at the same time every day, or to figure out the most appropriate regimen for you.
How often do I see my Infectious Disease doctor?
The frequency with which you see your doctor will depend on several factors including how recently you were diagnosed, what your viral load and CD4 count is, whether you recently changed providers, have any other sexually transmitted infections, and if you started a new medication or changed your ART. Your provider will advise you on when you should come for your next appointment. However, as a general rule, if a person has been undetectable for at least 6 months and has a “normal” CD4 count they will only need to see their HIV Provider every 6 months.
How can I protect myself and others?
Can using condoms prevent me from getting the HIV virus? There are a number of steps people can take to avoid passing HIV to others. To avoid passing the virus to others, people living with HIV are encouraged to see their healthcare provider regularly. When someone stays in healthcare and takes their medication, that person will have a higher likelihood of being virally suppressed (also known as undetectable). Undetectable means the virus is present at such low levels that it is not detected in blood. Having a consistently undetectable viral load for 6 months and beyond greatly lowers your chance of transmitting the virus to your sexual partners who are HIV-negative. Because of U=U (undetectable = untransmittable), we now know the risk of sexual transmission of HIV from someone with a fully suppressed HIV viral load is negligible, meaning so small or insignificant it is hardly worth considering. Depending on the comfort level of each partner, other prevention methods such as use of condoms or PrEP may be used (for more information on PrEP, see "Is there a medication to prevent contracting the HIV virus?" below).
Is there a medication to prevent contracting the HIV virus?
People who have a negative HIV test result but would like to reduce the risk of HIV may want to consider Pre-Exposure Prophylaxis (PrEP). PrEP is a daily pill that people take so they can reduce their worry about acquiring HIV, and keep HIV from entering your body.
You may want to consider taking PrEP if you are:
- A gay or bisexual man who has unprotected sex
- A transgender woman who has sex with men
- In a relationship with a person who is living with HIV
- Someone who has condomless sex with multiple partners
- A person who has been diagnosed with an STD in the past 6 months
- People who have injected drugs in the past six months and have shared needles or works
- Considering getting pregnant and have a partner who is living with HIV.
If taken daily, PrEP works very well at preventing HIV. People wishing to take PrEP need to see their healthcare provider for a prescription, and follow up with testing every 3 months. Many insurance plans, including Medicaid and private health insurances will cover the cost of PrEP.
Programs that help pay for PrEP include:
- Gilead medication assistance program for people who do not have health coverage, visit http://www.truvada.com/truvada-patientassistance or call 1-855-330-5479.
- Co-pay Coupon Card from the drug manufacturer if you have health coverage but the amount of medication co-pay would present a financial challenge, you may be eligible for one. Visit https://www.gileadadvancingaccess.com/copay-coupon-card call 1-877-505-6986 for more information.
- Patient Advocate Foundation Co-Pay Relief Fund- Provides financial assistance to financially and medically qualified patients for copayments, co-insurance, and deductibles. Patients, their medical providers, or their pharmacists may submit applications 24 hours a day via the Online Application Portal at www.copays.org/gateway or Monday - Friday 8:30am – 5:30pm EST via phone at (866) 512-3861.
- Partnership for Prescription- Designed to help uninsured Americans get the prescription medicines they need at no or low cost. Visit www.pparx.org, enter the names of the medicines taken and answer a few questions to determine what options are available. Call the toll-free number if there is difficulty with the web site. Call toll-free 1-888-4PPA-NOW (1-888-477-2669) for a trained specialist to answer questions and help with the application.
- PrEP-AP – A NYS Health Department program to assist people without insurance or who are underinsured with the cost of health care appointments or lab work needed for people taking PrEP.
For more information regarding how to pay for your PrEP Prescription or finding a PrEP Provider, please contact our PrEP Specialist at (631) 559-6138 or visit the NYS DOH website.
All questions answered with information from the NYS Department of Health: https://www.health.ny.gov/publications/0213.pdf and https://www.health.ny.gov/diseases/aids/
US Department of Veteran Affairs: https://www.hiv.va.gov/index.asp