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Do sudden small spikes in viral load represent the bleeding edge of drug resistance and treatment failure, or are they clinically insignificant, transient phenomena? To answer this question, researchers at Johns Hopkins recruited 10 patients between June 2003 and February 2004 who had maintained viral loads <50 copies/mL on a stable antiretroviral regimen for at least 6 months. These patients underwent intensive virologic investigations during 36 study visits over approximately 3 months. Samples from each visit were submitted to two independent laboratories for viral-load testing, viral-genome sequencing, and drug-concentration monitoring. Patients completed an adherence questionnaire at each visit. Most patients had begun antiretroviral th…