Question

My viral load is now 260 and I can’t get another viral load test?

23 October 2024. Related: All topics, CD4 and viral load.

My viral load was less 50 last year 2023. Now this year it’s 260 and I don’t know what’s going on?

And in my country we only test viral load once a year, what should I do to make it less?

Answer

Answer: Simon Collins

Hi there

Thanks, this is tricky because you need to know whether it either:

1. Goes back to undetectable again, or
2. Continues to increase.

Your doctor should take this seriously and try to find out if any recent changes could have caused this.

Even if you always take all your meds on time, your doctor will think you might not. So they will ask about adherence and say to be extra careful about taking them at the same time every day. For many people this is enough to become undetectable again.

The doctor will also ask about any other meds you take, or supplements including vitamins etc to check for any drug interactions which could reduce the drug levels of your HIV meds.

Your doctor will check you are following food advice if needed. For an HIV combination that includes dolutegravir (ie TLD) you could start taking this with food. Even though the directions say ‘with or without food’, taking with food increases drug levels a little.

They will also ask about whether you have had any other recent infections or any vaccines. Both this things can cause viral load to increase a little, which then goes down again a few weeks later.

All these things are included in more detail in this guide to viral load rebound:
https://i-base.info/guides/changing

This is the page with more info on reasons viral load can rebound:
https://i-base.info/guides/changing/reasons

Please also ask about having your viral load checked again.

You didn’t say which country you are in but World Health Organization (WHO) guidelines recommend that you have a second test to check now and not just wait for another year.

If your country doesn’t have its own guidelines it is likely to use the WHO ones.

Please say to your doctor that you need to have this second test in a month after everything else has been checked.

This is because if none of the things above are responsible, there is a small chance you might have early drug resistance. If so, then waiting a year would make this much more serious. This includes a higher risk of transmission to partners if you currently use U=U.

In the UK, and in WHO guidelines, the second viral load test is important.

If you want to, please let me know how you get on as I am interested.

Maybe also show your doctor this online post if it would help.