Quantifying HIV for Monitoring Antiretroviral Therapy in Resource‐Poor Settings

Abstract

There is increasing evidence to support the inability of CD4 cell count monitoring to predict virological failure in human immunodeficiency virus-infected individuals receiving antiretroviral therapy. There is renewed interest in improving access to viral load monitoring in resource-constrained regions to monitor adherence to treatment and to switch therapy. The field is rapidly changing as new technology platforms are made available for evaluation. This article presents an up to date summary of the assays available for viral load monitoring and suggests approaches for their implementation.

Low-cost tools for diagnosing and monitoring HIV infection in low-resource settings

“…29 Several reports support the use of the EXAVir Load Version 3 nucleic acid test for HIV load monitoring in the developing world. 14,[29][30][31] In this test, a gel-separation step isolates virions from plasma components. The virions are then lysed and the lysates undergo a modified ELISA to measure the activity of reverse transcriptase.…”

“…p24 immunoassays are no longer considered for this activity, however, because of their low sensitivity, the high variability of the results between assays and the difficulty in standardizing the correlation between p24 and virus load in persons receiving ART. 14,33,34 …”

Point of care testing of HIV in children younger than 18 months with three different HIV virological assays. Experience from a district hospital in a resource-limited setting

“…18 The results of this and previous studies suggest that HIV RNA PCR assays may be preferable, especially if they are able to process dried blood spots. 19 False negative results can falsely reassure health workers and parents and, therefore, avert the initiation of HIV treatment for reducing the risk of death during the first years of life. 1 Plasma HIV RNA PCR and RT activity assays had good sensitivity and specificity and had shorter turnaround time.…”

Laboratory Evaluation of the Liat HIV Quant (IQuum) Whole-Blood and Plasma HIV-1 Viral Load Assays for Point-of-Care Testing in South Africa

“…VL testing has been used in the diagnosis of HIV acute infection (2) and early infant diagnosis (EID; Ͻ18 months of age) (3,4); however,VL testing may be limited in the developing world, and EID still is widely performed with a qualitative test and VL is used as a secondary test (5). Several well-established VL technologies are available (6) in high-throughput and, more recently, ultrahighthroughput platforms designed for centralized laboratories with good quality control. There is a dire need to increase access to VL testing in resource-limited settings (7) and to simplify and improve efficiency in diagnostics to ensure patient care is not compromised.…”