Abstract Objective: To investigate the long-term impact of plasma VL elevations between 50 and 199 copies/ml (VLE50-199) on virological failure and development of AIDS, death or non-AIDS events (NAE) in patients receiving ART. Methods: We analyzed ART-naïve adults from the cohort of the Spanish AIDS Research Network (CoRIS) who initiated ART from 2012 to 2017 and achieved VL<50 copies/ml within 3–9 months after ART initiation. Elevations of VL between 50 and 199 copies/ml were divided into uncommon (<25% of the measurements) or not viral elevation, frequent (25-50%) and very frequent (>50% of the measurements). Multivariate Cox models were used. Results: Of 4121 patients included, 3881 (94.2%) patients VLE50-199 was uncommon or was not present. VLE50-199 was frequent in 185 (4.5%) and very frequent in 55 (1.3%) patients. 169 had virological failure (4.1%), 57 (1.38%) patients died or developed an AIDS event and 107 (2.6%) developed NAE. Frequent VLE50-199 (aHR, 11.83; 95% CI, 6.42–21.84; p<0.001) and very frequent VLE50-199 (aHR, 29.1; 95% CI, 12.6–67.19; p<0.001) were associated with a higher risk of virological failure, but did not increase the risk of developing AIDS events or death. Frequent VLE50-199 had an adjusted NAE hazard ratio of 2.13 (95% CI, 0.91–4.97;p=0.081) and very frequent VLE50-199 of 4.66 (95% CI, 0.9–21; p=0.051). Conclusion: Persistent mild elevations between 50 and 199 copies/ml were strongly associated with an increased risk of virological failure and with higher rates of NAE. Therefore, closer monitoring of these patients may be warranted.