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When should I change and which drugs can I use?

Different guidelines can recommend different ways to manage changing treatment.

The UK, Europe, the US and most high-income countries recommend changing treatment if viral load is above 200 or 500 copies/mL. This is because drug resistance tests are available and because there are usually more drugs to choose from.

WHO guidelines for low- and middle-income countries wait until viral load rebounds higher than 1000 copies/mL.

Changing ART should stop drug resistance becoming more serious.

With some drug classes, switching early might mean you can still use other drugs in the same class. This is especially important for NNRTIs and integrase inhibitors.

Each person will be different. The timing for when you change will depend on how high viral load has rebounded.

It will also depend on the reasons for the rebound.

Your treatment history is important when choosing your next ART.

• Sometimes you can change all your drugs.
• Sometimes you can just change one or two drugs.
• Sometimes you can just add one drug to intensify treatment. This is not generally recommended.

Last updated: 1 January 2025.