Kathryn Anastos, M.D., proposed distinct timepoints for viral load testing to optimize the information such tests provide:

• at serodiagnosis, to drive decisions about initial antiretroviral therapy;

• before changing or starting any new antiretroviral therapy;

• approximately four weeks after starting or changing antiretroviral therapy (look for at least a one-log or ten-fold decrease or, ideally, an undetectable viral load);

• 12 weeks after switching or changing a regimen, which Dr. Anastos called "the best time to detect the viral load nadir [the lowest point to which the drug regimen will push the viral load]"; and

• every 3-4 months in people on stable therapy or in those not taking any antiretroviral therapy [who, Dr. Anastos added, should be only those with high CD4 cell counts and no detectable viral load].

Dr. Anastos offered a suggestion for people looking to switch therapy because of unacceptable side effects: "Before switching, first achieve a very low viral load to minimize the possibility of viral rebound, because you get a better shot at suppressing the virus with a new regimen if you switch when viral load is low."

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