I have been on sustiva and epzicom for several years and my viral load has been undetectable but my last test showed a viral load jump from below 50 to 87. Should I worry about this, or just wait until the next test in three months to see if this could be a problem?


You should not worry about this, and simply ensure that you are taking each and every dose of your medication as prescribed every 24 hours. As long as you attend to the important issue of taking your medications correctly (as well as keeping your regular MD appointments), you are doing everything that you can to get the greatest possible benefit out of your ART regimen. You can safely wait until the next test to judge whether or not this is a problem, for two reasons.

'Blips' are minor increases in the viral load of 50-1,000 copies/ml that are quite common, occurring in 40% of people who have excellent control of their viral load on ART. Most often the viral load at the next visit returns to undetectable. So there is a good chance that this represents a blip.

The second reason is the very small degree of increase, i.e. from the lower threshold of <50 to 87, which is very close to the lower limit, and within the margin of error for the test itself.

Finally, there is a remote possibility that this represents the first development of drug resistance, and the next value will fall outside the range of a blip, i.e. > 1,000 copies/ml. In that case, your doctor will request a resistance test to see whether drug resistance has resulted from this episode of viremia, and to help to determine the next best course of management and alternate ART regimen for you.

In sum, take all of your medications as prescribed, and you and your doctor can check the next viral load value to determine whether this was simply a blip, or whether further testing is required.

I encourage you to ask this question of your doctor, and to take a copy of these suggestions with you for your information.