The other day I met a patient in the clinic who made me realize once again that the importance of testing viral load after antiviral therapy cannot be overemphasized. The patient had been on treatment for more than two years, and the first viral load test was more than 4,000 a year after treatment, so the doctor at the local hospital said it was not a big problem and to keep taking the medication. When the viral load became more than 8000 in the second year, the doctor told him to go to Youan Hospital to do a drug resistance test. I don’t mean to accuse the local doctor. The distribution of medical resources in China is extremely uneven, especially in the case of HIV care. Some areas have very few AIDS patients, so the local doctors have very little experience. It’s not that they don’t try. Even with good training, if they don’t see patients often, they may forget. A viral load of over 4000 after 1 year of treatment is not a minor problem, it is a major one. 6 months of treatment and the viral load is a treatment failure if it is still greater than 50. Of course, each country, region or organization has different standards. The standard for failure in the United States is higher than 200 at 6 months, the World Health Organization is 1000, free treatment in China is 400, and the standard implemented in our clinic is the European standard, which is considered failure above 50. Generally speaking, below 1000, drug resistance is less likely, and it may not be possible to do drug resistance testing with a viral load below 1000. Therefore, we must not keep our eyes on the “small four” in the future. In determining the efficacy of the treatment, the small four is certainly important, but it is not the most important. For patients with a well-controlled viral load and a CD4 that has risen to a certain level (e.g., 350), CD4 testing every 6 to 12 months is perfectly fine. And with viral load, it never hurts to test more often. The current national free treatment policy is once a year, and as long as the test results are timely, it seems to be fine for the majority of patients at this point. However, ideally, it could be done twice a year. The first year can be more, for example, testing 3 months, 6 months, 12 months after treatment. If switching medications after resistance, it is also recommended to test viral load 3, 6, and 12 months after the switch.