Question

My viral load has increased, should I be worried?

1 January 2020. Related: All topics, CD4 and viral load, Changing treatment, Resistance.

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

Answer: Simon Collins

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.