Cooley SA, Navid J, Wisch JK, et al. - Researchers investigated if recommended viral load (VL) classifications by the Department of Health and Human Services map onto changes in brain integrity detected in people living with HIV (PLWH). They examined cognition and brain volumes from 10 regions of interest that are sensitive to HIV in 349 PLWH who were on combination antiretroviral therapy meeting criteria for virologic suppression (VS) (VL ≤ 20 copies/mL; n = 206), “low-level viremia” (20–200 copies/mL; n = 63), or virologic failure (VF) (> 200 copies/mL; n = 80) as well as in 195 demographically similar HIV-negative controls. HIV-negative control and VS groups differed significantly from the VF groups in terms of cognition and brain volumes. Longitudinally, greater decline in cognition and brain volumes were evident in PLWH who continued to have VF vs PLWH who remained with VS. Correlation of observed longitudinal changes in cognition was evident with brain volume changes. Findings suggest that in PLWH with continued VF, change in treatment may benefit in addition to consideration of other potential etiologies of VF to lower the loss of brain integrity.