When Does Viral Load Warrant Switching HIV Meds? (Editor's Pick)



I have had HIV for 12 years and have been taking Sustiva and Epzicom for the entire time. My viral load has consistently been less than 50, usually less than 25. My CD4 has hovered consistently in the 800 range. My most recent test came back with a VL of <40 and my physician says that it may be time to change my medications because my VL is not <25 which he says is the new standard for undetectable and my VL of 40 might mean I have developed resistance to my current medications and it would be better to switch the regimen now before the VL goes too high. I'm having a difficult time buying into this approach. Can you advise, please?


This is a very controversial area, and one of active research. Some experts believe that the HIV viral load needs to be essentially zero in the blood in order for HIV treatment to maximally effective and failure free. There are reports in literature of viral load rebounding and the regimen failing when the viral load is > 20 copies/mL. But this is only in a small minority and it is not clear from the studies what characteristic predict who will or will not fail their regimen. The literature is more clear when the viral load is > 200 copies/mL that people will fail on their regimen. So we have this zone of controversy between 20 and 200 copies/mL. In general, most providers are not rushing to change regimens in this zone and just watching the viral load levels carefully. The data is also mixed on whether changing or adding HIV meds at these levels is of any benefit.