Hello, I've been reading some of questions about blips. Many of them seem to have been posed when the undetectable lever was <48. My question is two-fold: 1. Are the new assays that measure viral load as undetectable at <20 more reliable? 2. If I have been undetectable for about a year on Epizcom + Prezista/Norvir with CD4 counts consistently 700-900, should I start being concerned with a blip at VL24? My doctor says that most of the literature has said that the small blips are not of great concern but that some of the recent studies show that perhaps they are. I guess I just want some reassurance. I have been scared to death since my diagnosis (December 2010).

Your doctor is correct. The literature is controversial on this point. Some studies have been performed with assays that have lower thresholds. Some studies, but not all, report that in majority (but not all) of the patients evaluated in their studies, people were more likely to experience HIV treatment failure than those who remained below 20 copies during all measurements. We have some clues as to why (in terms of patient characteristics) but they are not consistent. We also don't have good strategies as to what to do about it. I would not be concerned about your current result.