title: Raised viral load in patients with viral suppression on highly active antiretroviral therapy: transient increase or treatment failure?
abstract: OBJECTIVE
  To assess the occurrence of viral load greater than 50 copies/ml in patients on highly active antiretroviral therapy (HAART) having achieved less than 50 copies/ml and the chance of whether a viral load greater than 50 copies/ml would lead to a sustained and increasing viral load.
  
  
  METHODS
  A cohort of 553 patients on HAART with viral loads of less than 50 copies/ml were followed.
  
  
  RESULTS
  Over a median of 56 weeks 35% of patients experienced a transient increase and 8% virological failure (two consecutive viral loads of > 400 copies/ml). Transient increases and virological failure were more common in those with greater drug experience, and those with initial raised viral load values of more than 400 copies/ml were more likely to have a sustained increase and become virological failures.
  
  
  CONCLUSIONS
  Transient increases in viral load are common, mainly in the 50-400 copies/ml range, and the majority of subsequent viral load estimations show a return to less than 50 copies/ml. A single raised viral load should lead to adherence support and intensified monitoring. Subsequent treatment decisions can then be based on evidence of true virological rebound and failure.
authors.affiliation: Department of Primary Care and Population Sciences and Centre for HIV Medicine, Royal Free and University College School of Medicine, Hampstead, London NW3 2PF, UK. antonia.moore@pcps.ucl.ac.uk
authors.forename: Antonia L
authors.initials: AL
authors.lastname: Moore
authors.forename: Mike
authors.initials: M
authors.lastname: Youle
authors.forename: Marc
authors.initials: M
authors.lastname: Lipman
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cozzi-Lepri
authors.forename: Fiona
authors.initials: F
authors.lastname: Lampe
authors.forename: Sarah
authors.initials: S
authors.lastname: Madge
authors.forename: Shrenee
authors.initials: S
authors.lastname: Nesaratnam
authors.forename: Mervyn
authors.initials: M
authors.lastname: Tyrer
authors.forename: Zoe
authors.initials: Z
authors.lastname: Cuthbertson
authors.forename: Darren
authors.initials: D
authors.lastname: Ransom
authors.forename: Clive
authors.initials: C
authors.lastname: Loveday
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Johnson
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Phillips
mesh_terms: D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome; D019562:Viral Load