Why can we get HIV to a viral load of 0 but can’t get rid of the virus?
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There are a few things different about HIV that together create this situation.
First, every test for something in the body has a limit of detection. For example, your average viral load test might be able to detect a few viruses in a small vial of blood (in reality it’s not this sensitive). However, this level of sensitivity still isn’t good enough to detect a very small amount of viruses hiding within hidden reservoirs in the body.
The above situation in particular can occur because the hiv genome is capable of integrating itself into cells in the body, and then lie dormant without producing any viruses. The drugs that we use to attack HIV only stop the virus from infecting new cells. We rely on the virus production process itself along with the natural turn over of cells to kill infected cells. If the virus isn’t being produced in a cell that’s long lived, the viral reservoirs can remain for a long time even when the virus itself is undetectable in your blood.
Once you stop treatment, some of these reservoirs will wake up and start making viruses again. Since HIV is a virus that attacks the immune system itself, the immune system can’t really deal with even a small number of hiv viruses, and so the viral load will go back up again.
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