Question 1

Can a single detectable viral load be called treatment failure?

Accepted Answer

No — WHO defines virologic failure as two consecutive viral load measurements ≥1,000 copies/mL with adherence support between tests. Transient blips (a single detectable value followed by suppression) are common and should not trigger a regimen change.

Question 2

How should I manage low-level viraemia (50–999 copies/mL)?

Accepted Answer

Exclude intercurrent infection, vaccination, or lab error. Reinforce adherence and repeat viral load in 3 months. Persistent low-level viraemia may signal emerging resistance and can justify resistance testing in selected patients, especially those on NNRTI-based regimens.

Question 3

What if viral load testing is not available?

Accepted Answer

In settings without access to routine viral load monitoring, WHO clinical and immunological (CD4) criteria remain the alternative for detecting treatment failure, though they have lower sensitivity and specificity than viral load-based monitoring.