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Viral Blip After Diarrhoea — SCE Infectious Diseases MCQ

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EasyHIV MedicineViral Blip After DiarrhoeaSCE Infectious Diseases

A 40-year-old man with HIV on DTG/TAF/FTC develops diarrhoea while travelling. He self-treats with Loperamide. His diarrhoea resolves. On return to the UK, his next viral load is unexpectedly elevated at 350 copies/mL (previously <50). What should be considered?

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Correct answer: B — Diarrhoea may have transiently impaired ART absorption — repeat VL in 2–4 weeks; if VL resuppresses, no regimen change needed; this is NOT necessarily treatment failure

Transient viraemia ('viral blip') can result from reduced ART absorption during GI illness (diarrhoea, vomiting). This does not constitute virological failure (defined as confirmed VL >200 on two consecutive samples). Management: confirm adherence, repeat VL in 2–4 weeks. If VL resuppresses to <50, no change is needed. If VL remains >200 on repeat testing, resistance testing and potential regimen review are indicated. This scenario is common in clinical practice and illustrates the importance of not over-reacting to a single elevated VL in the context of intercurrent illness.

Reference: BHIVA 2025 – ART monitoring; EACS 2025