Q and A

Question

My viral load has increased, should I be worried?

Last November my viral load was 30 and my CD4 was 351. My results today show my viral load is 90 and my CD4 is 479.

Should I be concerned with the rise in viral load?

Answer

An increase in viral load after becoming undetectable (under 50) is not uncommon. But if you have been taking your meds and this is still less than 100, then this is either a blip or a lab error. Please don’t worry.

UK guidelines (British HIV Association, BHIVA) recommend repeating a viral load test on the day that you receive a result showing an increase. This is to find out whether the first test produced an accurate result.

There are two reasons why this increase may not be significant.

  1. It could just be a ‘blip’. This can be anything from over 50 to 200, but can sometimes be higher. Other infections such as flu. herpes or COVID, or a recent vaccination can cause a blip.
  2. It could also be a lab error. One study showed that over 50% of blips between 50 and 500 copies/mL were test errors.

Even when this is likely to be a ‘blip’ it’s still important to check. This is because resistance can still develop if viral load stays detectable for a long time. This is even when viral load is relatively low (50-500). This could stop ART working. That’s why it’s important to get another test to check this result.

More information about viral load blips and drug resistance is in the guide to Changing treatment and drug resistance.

This answer was updated in January 2020 from a question first posted on 27 May 2012.

20 comments

  1. Lisa Thorley

    Hi Martin,

    Have you been adhering to your medication? What’s your viral load history?

  2. Martin

    My VL has gone thru the roof to over 2000 copies. What are my health concerns.

  3. Roy Trevelion

    Hi Siphelele,

    A viral load result of 90 copies/mL could just be a blip. A blip is when viral load goes above 50 copies/mL for a short time and then drops back down.

    Please see this link for more info.

    You can ask your doctor for another viral load test to check this.

    Your CD4 count is strong. What HIV meds are you taking? Please let us know how the treatment is going.

  4. Siphelele

    My CD is 1666 and viral load has increased from udetectable to 90…what is the cause of this

  5. Roy Trevelion

    Hi Victoria,

    Please can you tell us more? What’s your latest viral load and CD4 results. And what HIV meds are you taking? Please let us know.

  6. victoria

    my viral load is not improving

  7. Lisa Thorley

    Hi Grace,

    If you’ve been adhering to your medication and your viral load is now detectable this may be an indication that the treatment that you’re on isn’t working like it should do. This is something you’ll need to talk to your doctor about.

  8. Grace

    My VL was undetectable for the past 10 years recently it has increased to 2063 copies m so worried recently was vaccinated at work for HPV prevention

  9. Roy Trevelion

    Hi Derick,

    Please see numbers 7 & 8 on these frequently asked questions.

  10. Derick

    What do i do to improve both the viral load and CD4

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