Confirmed viral rebound

The second test can confirm viral rebound if the result is still detectable. The result will often be much higher.

This is only if you have been taking your meds. See Figure 2.

The higher your viral load goes, the more likely that resistance will develop. Resistance first develops to one drug. Over time it can then develop to all of the drugs in your ART.

Once resistance is detected most guidelines in high-income countries recommend changing treatment.

This is because resistance can still develop when viral load is still low (between 50 – 500). WHO guidelines for low- and middle-income countries are based on waiting until viral load is higher than 1000 copies/mL.

Sometimes, if resistance is detected early, the dose of some meds can be increased.

Figure 2. Viral load rebound

 

If the second viral load test is still detectable, this is more likely to be a real rebound. But only if someone has been taking their meds.

This can be a reason to change treatment.

Last updated: 1 January 2025.