Hi my hospital is now using a newer way of measuring the VL. Previously we were told we were < 40 or higher, now its < 20. Apart from the obvious difference is there any actually benefit in this difference. Recently my bloods were shown to be <27 after being <20, should I be concerned seeing as a few months ago both would be fine. Is this not just going to cause anxiety over nothing.? And how low should we go/aim for? Thanks.

That is a great question. We have been operating under the assumption for the last several years that < 50/ < 40 are where patients need to be. This is still likely to be the case. Newer versions of viral load tests (so-called supersensitive assays) are pushing the detection limit down toward zero. There is some data to suggest that any circulating virus that can be measured could lead to failure of a particular regimen. But we would really need a randomized prospective clinical trial to determine whether there is a clinical benefit of knowing and maintaining the level below 20 or below 5.