Spikes and blips

It is common to have a ‘spike’ or ‘blip’ result. Most blips are never detected (because viral load is only tested every few months. A blip is when your viral load jumps from undetectable and then drops back down below detection by itself within a few weeks. See Figure 6 below.

Blips can be anything from over 50 up to 2000, but are usually to less than 500. They can be caused by other infections, such as flu or herpes, or a recent vaccination.

Also, tests can be contaminated at the lab giving a false result. One study showed that over 50% of blips to between 50 and 500 copies/mL were test errors. These lab errors can occur with all viral load tests.

The confirmatory test will show whether the treatment is really failing.

If the second test also shows your viral load at a similar or higher level, and you have been taking all the prescribed drugs, it is likely you have started to develop resistance to some or all of the drugs in your combination. See Figure 7 bottom of page.

Figure 6: A single spike or blip is common

When viral load is undetectable (less than 50), it is often less than 5 copies/mL.

A single blip above 50 is common and doesn’t mean you need to change treatment.

If it is really a blip, it will be undetectable again with the confirmatory test.

Figure 7: A real viral rebound will be confirmed by the confirmatory test

If viral load becomes detectable, have a second viral load test to confirm this.

If the confirmatory test shows that viral load is still detectable, this is likely to be a real rebound.

You need a confirmatory test result before you change treatment.