HIV Virological Monitoring — SCE Infectious Diseases MCQ

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ModerateHIV MedicineHIV Virological MonitoringSCE Infectious Diseases

A 34-year-old man with HIV (CD4 490, VL <50 on BIC/TAF/FTC) reports persistent low-level viraemia on two consecutive samples: 68 copies/mL then 82 copies/mL. His adherence is confirmed by pill counts and pharmacy refill data. He has no resistance mutations on baseline genotype. What is the most appropriate interpretation?

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Correct answer: D — Low-level viraemia (50–200 copies/mL); continue current ART and monitor — this does not constitute virological failure

The two confirmed HIV RNA results, 68 and 82 copies/mL, fall within low-level viraemia (50–200 copies/mL). Under UK/BHIVA practice this does not meet the threshold for virological failure, which requires confirmed rebound above 200 copies/mL or incomplete suppression above 200 copies/mL. In a patient on a high-genetic-barrier integrase regimen such as BIC/TAF/FTC, with adherence confirmed and no baseline resistance, the appropriate interpretation is persistent low-level viraemia: continue the current ART, review for adherence/drug–drug interaction issues, and monitor viral load rather than switching ART or assuming emergent resistance.

Reference: British HIV Association (BHIVA). BHIVA guidelines on antiretroviral treatment for adults living with HIV-1 2022 (2025 interim update), section 7.2: blips, low-level viraemia and virological failure. https://bhiva.org/clinical-guideline/hiv-1-treatment-guidelines/