"Do spikes in the viral load cancel the effectiveness of my medications?"

Low level spikes in viral load (up to say, 500 copies/mL) are often not significant. They are often random results or may relate to occasional non-adherence to medications. I take this as an opportunity to go over the medications with my patient and make sure they are being taken regularly, and appropriately (with or without food, once or twice a day, etc...). This may lead to a small change in the routine of taking the medications, increases adherence just that little bit and the next viral load is undetectable again, and the long-term efficacy of the regimen is preserved.

If the spikes in viral load are higher (say > 2,000 copies/mL) this may be more of a cause for concern with respect to high-level breakthrough, the dewvelopment of drug resistance and the need to change therapy. There is a more urgent need to go over adherence, and repeat viral load testing in the near future to establish if there is a trend towards failure of the regimen.