Q and A

Question

My viral load is undetectable, will it rebound?

Hi, so I am a 29 year old heterosexual male and have been taking Stribild and later Genvoya for more than 5 years now. I have good adherence and have remained undetectable. I understand that risk is of transmission to a partner even without condoms would be negligible as long as that remains the case. However my check-ups where I get my viral load counts are only every three months so I have these questions:

– If resistances were unexpectedly to develop, how fast could my viral load increase in the three-months span in between checkups? Could it realistically increase fast enough for me to be a risk to someone?
– In the rare event that I do miss a single dose, how much would viral load increase from that and, if nothing else happens, how fast would it decrease again to undetectable levels?

I really appreciate your efforts and with them hope to better be able to reassure future partners.

Answer

Thanks for getting in touch.

We have lots of accumulated data that in the context of generally good adherence, viral loads very rarely rebound.
This supports the decision to reduce the need for such frequent viral load and CD4 tests (in the UK you might have a viral load test every 6 months and a CD4 even every few years once your HIV is under control).  This means that when one thinks about their viral load rebounding when they adhere to their treatment, it’s a theoretical concern,  rather than real concern.
This noted, it’s not uncommon for people  to still worry about their viral load, and that it  may suddenly rebound, even after years of effective treatment. The key here is adherence, as long as you adhere, you’ll stay undetectable.
In the rare cases that a person’s’ viral load  might rebound, this is  likely  to be due to starting another medicine that perhaps interacts.

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