Raised viral load in patients with viral suppression on highly active antiretroviral therapy: transient increase or treatment failure?
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.
Moore
Antonia L
AL
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
Youle
Mike
M
Lipman
Marc
M
Cozzi-Lepri
Alessandro
A
Lampe
Fiona
F
Madge
Sarah
S
Nesaratnam
Shrenee
S
Tyrer
Mervyn
M
Cuthbertson
Zoe
Z
Ransom
Darren
D
Loveday
Clive
C
Johnson
Margaret A
MA
Phillips
Andrew N
AN
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