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Raised viral load in patients with viral suppression on highly active antiretroviral therapy: transient increase or treatment failure?

Moore, Antonia L.; Youle, Mike; Lipman, Marc; Cozzi-Lepri, Alessandro; Lampe, Fiona; Madge, Sarah; Nesaratnam, Shrenee; Tyrer, Mervyn; Cuthbertson, Zoe; Ransom, Darren; Loveday, Clive; Johnson, Margaret A.; Phillips, Andrew N.*; on behalf of the Royal Free Centre for HIV Medicine

Clinical: Concise Communications

Objective: To assess the occurrence of viral load greater than 50 copies/ml in patients on highly active antiretroviral therapy (HAART) having achieved less than 50 copies/ml and the chance of whether a viral load greater than 50 copies/ml would lead to a sustained and increasing viral load.

Design: A cohort of 553 patients on HAART with viral loads of less than 50 copies/ml were followed.

Results: Over a median of 56 weeks 35% of patients experienced a transient increase and 8% virological failure (two consecutive viral loads of > 400 copies/ml). Transient increases and virological failure were more common in those with greater drug experience, and those with initial raised viral load values of more than 400 copies/ml were more likely to have a sustained increase and become virological failures.

Conclusion: Transient increases in viral load are common, mainly in the 50–400 copies/ml range, and the majority of subsequent viral load estimations show a return to less than 50 copies/ml. A single raised viral load should lead to adherence support and intensified monitoring. Subsequent treatment decisions can then be based on evidence of true virological rebound and failure.

From the Department of Primary Care and Population Sciences and Centre for HIV Medicine, Royal Free and University College School of Medicine, Hampstead, London NW3 2PF, UK.

Correspondence and requests for reprints to: Antonia Moore, Department of Primary Care and Population Sciences and Centre for HIV Medicine, Royal Free and University College School of Medicine, Hampstead, London NW3 2PF, UK. E-mail: antonia.moore@pcps.ucl.ac.uk

*See Appendix for all the members of the Royal Free Centre for HIV Medicine.

Received: 20 July 2001;

revised: 5 November 2001; accepted: 7 November 2001.

© 2002 Lippincott Williams & Wilkins, Inc.