Role of HIV-1 Viral Load in Initiating Antiretroviral Therapy

Nayana A Ingole,Preeti R Mehta,Seema M Kukreja

doi:10.4236/wja.2011.14022

Abstract

Purpose: For commencement of Antiretroviral Therapy (ART), CD4 count and/or WHO clinical staging is used as the guide in India. In western countries along with clinical and immunological criteria, HIV-1 viral load is also used to start the patient on treatment. The present study was conducted to determine the role of viral load in taking decision on ART commencement in HIV-1 infected treatment naïve individuals. Method: A cross sectional study was carried out at the Integrated Counseling and Testing Centre (ICTC) in the Department of Microbiology at a Tertiary care teaching hospital after Institutional Ethics Committee approval. After obtaining written informed consent, HIV-1 infected patients who were clinically asymptomatic, ART naïve, having CD4 count ® TaqMan® HIV-1 Test. Result: During the study period of one year, 8966 HIV-1 infected patients were referred for CD4 count estimation. Of these 1624 patients had CD4 count <250 cells/mm3 and 405 patients were treatment naïve. Of these 96 (23.70%) patients were clinically asymptomatic and were enrolled. Of those enrolled, ten (10.41%) had viral load less than 5000 copies/ml. Conclusion: Decision to start patient on ART can be made judiciously when viral load is used along with CD4 count estimation.

Highlights

In developed countries viral load monitoring along with CD4 count estimation is used to make decision regarding commencement of Antiretroviral Therapy (ART) in an HIV infected individual.Viral load testing is important as a guide for clinical decision making as regards initiation of treatment, switching to second-line treatment and optimizing the duration of the first-line treatment regimen
For developing countries, World Health Organization (WHO) recommends starting ART when CD4 count falls below 350 cells/mm3 or when patient is in WHO clinical stage III or IV if CD4 testing is not available [2]
National AIDS Control Organization (NACO) recommends initiating therapy when patient is in WHO clinical stage III and IV or when CD4 count < 250 cells/mm3 [3]

Summary

Introduction

In developed countries viral load monitoring along with CD4 count estimation is used to make decision regarding commencement of Antiretroviral Therapy (ART) in an HIV infected individual. National AIDS Control Organization (NACO) recommends initiating therapy when patient is in WHO clinical stage III and IV or when CD4 count < 250 cells/mm3 [3]. It is a standard practice in high-income countries, determination of the HIV viral load is not recommended in developing countries because of the costs and technical constraints. This study was conducted to determine whether performing HIV-1 viral load can lead to better decisions in initiating therapy

Estimation of HIV Viral Load

Specimen Collection and Storage

Results

Discussion