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Changing treatment due to failure
As mentioned above, the goal of anti-HIV treatment, if you are taking it for the first time, is to reduce your viral load to below the limit of detection, which, using current tests, is 50 copies/ml. If your viral load doesn’t fall below this level, then it’s more likely that your treatments won’t suppress HIV for long.
If your viral load falls below 50, then rebounds to above 50 on two consecutive tests, then it means that your treatment is failing. You may find that your CD4 cell count starts to fall, which will mean that your risk of becoming ill because of HIV increases.
If your treatment fails to get your viral load below 50, or it rebounds above this level, then there’s a possible risk that you will develop resistance to some or all of the anti-HIV drugs you are taking.
If your treatment is not suppressing your viral load to undetectable levels, it should be changed.
Occasionally, your viral load may rise a little above 50 before dropping down to undetectable levels on the next test. These changes are called ‘blips’ and mean that you should have your viral load retested as soon as possible. Blips are often due to a problem with the testing equipment, but could be a warning sign of other problems, such as treatment failure, drug interactions, poor adherence or illness.
If you have two viral load tests at least a month apart and both show that your viral load is above 400, then a treatment change should be considered. It’s recommended that you have a resistance test to see which of your drugs isn’t working and to help you choose replacement drugs. These tests are only accurate if your viral load is above 1,000, and if you change drugs due to treatment failure without having a resistance test, it’s recommended that your new treatment regimen consists of a completely new set of drugs.
If you have to change treatments because of side-effects and have an undetectable viral load, then it’s completely safe to only switch the drug or drugs causing the problem.
Anti-HIV drugs have to be taken very consistently to work properly (this is called adherence), so if you haven’t been taking your treatment properly for any reason, make sure that you switch to a new combination which is easier to take, and fits in with the way you live your life.