Unlike long ago when testing positive for HIV was regarded as a death sentence, the introduction of antiretroviral (ARVs) drugs has changed the perception to a mere diagnosis.
With proper adherence to the right medication, different findings have indicated that the virus is suppressed to undetectable levels in the blood. One is therefore able to live a normal life as long as they keep taking their medication as suppression is not permanent.
The standard antiretroviral therapy (ART) consists of a combination of Antiretroviral drugs (ARVs) to maximally suppress HIV in your body to undetectable levels and stop its progression, according to the World Health Organisation (WHO).
Once the right drugs are taken in equal measures at the right time, they also prevent onward transmission of HIV, according to WHO.
This justifies the reductions seen in rates of death and infections when use is made of a potent ARV regimen, particularly in early stages of the disease.
This, however, takes an extra effort by one adhering to treatment and practicing healthy behaviour.
For 33 years now, politician-turned HIV/Aids activist Maj (RTD) Rubaramira Ruranga has lived an absolutely normal life as a person living with HIV, owing to proper adherence to his ARV drugs and a healthy lifestyle. This has kept his viral load in the body constantly undetectable. Although he got infected in as early as 1985 before ARVs were introduced, he was able to equip himself with the knowledge and information on how to boost his immune virus through lifestyle changes. There were no drugs at the time to help him suppress the viral load in the body.
“I was a bad smoker and drinker that I had to abandon all those,” Maj Rubaramira says.
Knowing the problem and stopping smoking and drinking, eating a balanced diet with fruits kept his immunity strong enough to be broken by the virus for 12 years until the drugs became available in Uganda in 1997.
“It [the introduction of drugs] was a walk over,” Maj Rubaramira says, adding that it is at this point that he started proper adherence to his medication which kept the virus in his body too low to affect his life and that of his wife.
With an undetectable viral load due to adherence he has managed to stay married to an HIV negative woman without infecting her. Maj Rubaramira says he takes his drugs within the prescribed time and measures promptly; he has been able to father six HIV negative children four of whom he has sired by HIV negative mothers.
“I do not use condoms. The advent of ARVs caused a lot of change. If you are undetectable, the virus levels are so low to cause any infection,” he says, adding that he has managed to stay in a discordant relationship for more than 18 years without infecting his partner.
The secret to proper adherence, the father of six says, is the ability for one to equip themselves with information on how to live a positive life.
“I encourage people not to hide [their status] and to make sure that they have people to support them,” says the 70-year-old. With the kind of support, Maj Rubaramira has got no chance to miss his medication because everyone around him is concerned and ready to remind him.
What is viral suppression?
Dr Stephen Watiti, a senior medical officer in HIV treatment, explains that viral suppression happens when the virus in the body is not seen and is below 1,000 copies per millilitre of blood.
“It means the virus in the body does not hurt the system,” he says adding that this can only be achieved if one swallows the drugs very well after every 24 hours. Dr Watiti says most of the ARVs take three months to suppress the virus to undetectable levels although the national policy puts viral load testing at six months for newly enrolled patients and one year for the continuing ones.
However, the new first line antiretroviral drug called Delutegravir that is yet to be rolled out to people living with HIV/Aids is said to suppress the virus within 28 days, according to Dr Watiti.
The senior medical officer also clarifies that having an undetectable viral load does not stop one from testing positive for HIV/Aids emphasising the need to continue taking medication and living a healthy lifestyle.
“The HIV test is an antibody test. So when you have HIV and we test, it will remain positive,” he says demystifying the myths that a person with an undetectable viral load may test negative and still be able to spread the virus.
With the virus at undetectable levels, Dr Watiti says there are very few chances of someone living with it infecting another either through sexual contact or even unborn babies to mothers living with the virus.
Different studies also indicate that there are 96 per cent chances that the person with an undetectable viral load will not infect another.
Dr Watiti, however, warns that one has to avoid risky behaviour such as drinking, smoking and having unprotected sex with other HIV infected people in order to keep their viral load at undetectable levels
“There is what they call primary resistance to drugs where one is infected by a person who has a different strain of the virus that is already resistant to drugs. This is what makes the viral load to increase and reappear in the body,” he warns.
One who is drinking and smoking may also forget to take their drugs on time which leads to both drug resistance and rise in the number of drugs in the body, he adds.
Once the virus is detectable in the body, Dr Watiti says one is vulnerable to many opportunistic diseases such as malaria and tuberculosis because it weakens their body’s immune system and can cause death if not suppressed. But one can still fail to have an undetectable viral load even with proper adherence to medicine and a healthy lifestyle due to secondary resistance to drugs which may occur when the virus gets used to them. This means one would have to be switched to a different combination of drugs.
As a national intervention to promote viral load suppression among people living with HIV/Aids and reduce new infections, Dr Joshua Musinguzi, the head of the HIV/Aids programme at Ministry of Health, says they have now revised to six monthly viral load monitoring during pregnancy till end of breastfeeding
“Mothers with a high viral load contribute significantly to new infant infections. So, we use the small window of intervention during pregnancy and breastfeeding through closer monitoring,” Dr Musinguzi notes.
Statistics from the Ministry of Health indicate that 1.1 million Ugandans out of the 1.3 living with HIV/Aids are on antiretroviral drugs. Of these, 83 per cent have their viral load suppressed to undetectable levels.
This has been attributed to the robust response done by the government to increase both treatment and viral load testing services with many players across the country through private public partnerships with hospitals.
As a result of the concerted efforts to fight HIV/Aids through viral load suppression, Dr Joshua Musinguzi says the number of HIV-related deaths have drastically reduced from 64,000 registered annually in the late 90s down to 26,000 in 2016.