If your viral load starts to rise, don’t panic - but do take it seriously.

Get a new test straight away to find out whether it is an accurate result. Get the new test results as soon as they are available this usually takes about 2 weeks.

If your viral load is continuing to rise, then changing quickly will give your next combination the best chance of success.

Consider why your current combination failed - resistance, adherence, drug absorption, or a combination of more than one reason.

Ask for a resistance test.

Choose the strongest combination for any salvage treatment, using as many new drugs that are not cross-resistant to previous drugs.

Monitor your new treatment carefully with a viral load test 2-4 weeks after the treatment change and then with regular viral load tests every 1-2 months. If you have problems with adherence or side-effects make sure you discuss these as soon as possible with your doctor.

Find out what new treatments are becoming available, especially through expanded access programmes. Don’t necessarily rush to take them if they are the only drugs you are not resistant to if you are otherwise in good health.

Keep up-to-date on the latest information such as multiple drug combinations and treatment interruption.

If your CD4 count is under 100 ask about Gm-CSF which can boost your immune system.

Remember that even if you have a detectable viral load and are waiting for new treatments, staying on treatment is likely to be much safer than just stopping all your drugs. This is especially true if your CD4 count is under 100.

Second- and third-line therapy is one of the most complicated areas in HIV treatment.