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
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.
- 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.
- 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.
Hello Meric and thanks for getting in touch.
Well done for getting undetectable in the first place and I am sorry for your experiences so far.
I understand this situation can be causing anxiety, however your doctor is taking appropriate steps to manage this.
From what you write, there is a great difference in your situation right now: you are under the care of doctors.
Your clinic is monitoring closely and will intervene further if things don’t develop as expected.
There are other ARVs they can try if this combination doesn’t work, don’t worry.
I would encourage you to be patient and continue the excellent job you have done by taking your medication so well.
Please let us know how things will develop.
I have been on treatment (dolutegravir + combination) since April, 2025. I had a very high VL -480.000- with a low cd4 counts -106-. I had also an aids defining conditon (cmv retinits) and co infection (cmv). Permamently lost my vision in my one eye. Just one month after in May my VL became 350 and cd4 became 227. Then june vL became 95 and July became 105. September 52 and December my VL dropped to 26 and cd4 became 270. And then i stopped using co-trimaxzole and cmv anti virals as my cd4 count was above 200, and of course continue my hiv medications. I am super adherent to my medications – always take at same time (21:30). However, in January my VL became 116 and two weeks after became 265. Now my doc add one more pill to my regimen as booster (doravirine) and will check my VL again in 4 weeks. I am very concerned that i will be in aids stage again.
Hello Vera and thanks so much for getting in touch.
A viral load of 200 copies just once, is called a blip.
Blips can happen from time to time but they don’t mean anything, so please don’t worry.
Your clinic should however follow up with one more viral load within a few weeks.
Please be careful and check for interactions with other medication and herbal supplements – they can prevent absorption of the ARVs which might cause resistance.
You can check for interactions here: https://www.hiv-druginteractions.org
A common interaction is by taking ARVs with supplements.
In that case you need to space them by 6 hours either way.
U=U was observed in people living with HIV with viral load up to 200 which means right now it still stands.
That might change if your viral load increases so until the time you get your new results it might be best to use condoms.
You don’t need to worry about any previous interactions as you are at the limit of no transmission.
https://i-base.info/u-equals-u/
My viral load was 30 last 7 months ago and I another viral load lab on 28th October 2025 to check my result yesterday being 2nd of December it shows 200, why? Can it still be transmitted to partner, and I’m taking my drugs frequently, pls I need help, thanks.
Hi Gugu – it is difficult to comment without know more. How high and low is the viral load and which meds are you taking? thanks
Hi, my vl has been going up and don’t understand how coz i have been taking my meds everyday, is it possible that it might go down again?