Luckily, modern ART is now very effective. Most people get an undetectable viral load on their first combination. With good adherence, viral load also stays undetectable.

There are also more choices if you do need to change treatment. The summary below are key points if your combination does fail. Each point is discussed in more detail later in this online guide.

  1. If your viral load becomes detectable, everything will be okay. But please take this seriously.
  2. This might just be a lab error or a blip. Ask for the test to be repeated straight away. Do not just wait until your next set of tests.
  3. This second test often will be undetectable again. This shows it was a lab error or a blip.
  4. But if the second test is still detectable, your doctor will ask you about adherence. If you had been missing doses, careful adherence might be all you need to do now. But if you had been good at taking your meds, your doctor needs to this. They can then look for other possible causes.
  5. Other causes could be if you already had drug resistance. Or maybe drug interactions with other meds or supplements.
  6. A resistance test will help decide what to do next. The results need to be interpreted by an expert.
  7. If you have to change meds, this will usually include at least two new drugs.  Good adherence now will be very important. Find out whether they need to be taken with or without food.
  8. If adherence was a problem, you might need extra support. This is so that the next meds don’t fail too.
  9. After changing treatment, check your viral load within 2–4 weeks. This will show if the new meds are working. Test every month until your viral load is undetectable. Talk to your doctor if you have problems with adherence or side effects.
  10. If this is your third or more combination, ask about ongoing research. Find out when new meds will be available. Or if you can join a research study.
  11. Don’t rush to use one new drug if it is the only one that will be active. If your CD4 count is still good, it is can sometimes be better to wait to use two new drugs together.
  12. If you are waiting for new meds it is still good to be on treatment. Your options will depend on your current health and CD4 count.

Everyone has a different history and your care now will be based on this.

Drug resistance is a specialist area of HIV care. If your doctor is not an expert, they will need to work with someone who is.

Last updated: 1 August 2021.