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. Roy Trevelion

    Hi Matheus,
    What is your viral load result, and what meds are you taking? Generally your viral load should be under 50 copies/mL after a year.

  2. Matheus

    Hi
    I have been on medication for almost a year, my CD4 were too low when I started but they have now gone up slightly. However, my viral is still going up, what should i do?

  3. Lisa Thorley

    Hi Susan.

    You have nothing to worry about. Your viral load is below 50, therefor you’re still undetectable. If it were detectable then this is something that you would potentially need to worry about. You’re doing just great.

  4. Susan

    Hi last year my viral load was 28 now it has increased to 42 I am on tribuss and multivitamin, should I ask my doctor to change the medication or what has gone wrong,
    Susan

  5. Roy Trevelion

    Hi Tshego,
    Has she just started HIV treatment (ART)? However, after the first few months viral load can have gone down dramatically. If on ART for a while it’s a good idea to ask the doctor if HIV has bounced back.

  6. Tshego

    Should I be worried course the doctor said her viral load is high?

  7. Lisa Thorley

    Hi Nosipho,

    The ARVs that you’re on will increase your viral load. So you’re already doing the best thing possible.

  8. Nosipho

    Whats should I do to increase my virus load because m using arvs and I never skip them

  9. Lisa Thorley

    Hi Silindile,

    How long have you been taking ARVs?

  10. Silindile

    Hi i m really worried today was going to collect my medication last mnth i did test for cd4 and viral load,then result came back CD4 is 750 and viral load is 111.Please help me what i can i do to decrease mi viral load

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