Reasons to change ART

There are three main reasons to change HIV treatment (ART).

  1. If your viral load never became undetectable.
  2. If your viral load was undetectable but starts to rise again (viral rebound).

In both cases your treatment could have failed.

This booklet is about these two situations.

A third reason to change is if you have difficult side effects. In this case, changing ART is also easy. It can make your life easier. Please see: Guide to side effects and quality of life.

Why is viral load important?

Viral load tests check how well ART is working. When you are on treatment this test is more important than your CD4 count.

If you are starting ART, it shows if the drugs are working.

If you are already on ART, it shows the meds are still working.

How accurate are viral load tests?

In the UK, viral load tests have a cut-off of 20, 40 or 50 copies/mL. Below this level, viral load is called undetectable.

All these tests are good. Actually, many people will have viral load less than 5 copies/mL, but the tests don’t measure this low.

However, viral load tests have “a three-fold window of error”.

This means that a result of 50 could really be anywhere between 16 (3-fold lower) and 150 (3-fold higher). A result of 500 could be anywhere between 50 and 1500.

This is why a detectable result needs a second test.

Last updated: 1 August 2021.