The measurement of HIV-1 viral load in resource-limited settings: how and where? Clin Lab 53(3-4):135-148

Laboratoire de Virologie, Centre Muraz, Bobo-Dioulasso, Burkina Faso, West Africa.
Clinical laboratory (Impact Factor: 1.13). 02/2007; 53(3-4):135-48.
Source: PubMed


There is an urgent need for low-cost, simple, and accurate human immunodeficiency virus type 1 (HIV-1) viral load monitoring technologies in resource-limited settings, particularly at the time of the scaling-up of first and second-line highly active antiretroviral therapies. This review describes the main characteristics and advantages/ disadvantages of three alternative HIV-1 viral load methods currently evaluated and used in developing countries, i.e., the Ultra p24 antigen assay, the ExaVir Load reverse transcriptase activity test, and 'home-made' real-time PCR HIV-1 RNA techniques. This review discusses clinical results obtained with these three technologies in terms of correlation with commercial HIV-1 RNA assays, the impact of HIV-1 genetic diversity on quantification, as well as their usefulness for both the early diagnosis of pediatric HIV-1 infection and monitoring of highly active antiretroviral therapy efficiency. In addition, different strategies for HIV-1 viral load monitoring are discussed according to laboratory facilities in resource-constrained settings.

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    • "Vaccine volunteers mount specific immune responses to the vaccine constructs, which react with many serological diagnostic tests, making future HIV diagnosis difficult, potentially unblinding trial staff, and negatively impacting society [148]. Similar assays may also be beneficial in resource-limited settings to monitor antiretroviral therapy (ART) effectiveness and the potential need to switch therapy [149]. In each of these cases, new rapid molecular POC HIV screening tests will fill an important diagnostic gap. "
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    ABSTRACT: Effective prevention of HIV/AIDS requires early diagnosis, initiation of therapy, and regular plasma viral load monitoring of the infected individual. In addition, incidence estimation using accurate and sensitive assays is needed to facilitate HIV prevention efforts in the public health setting. Therefore, more affordable and accessible point-of-care (POC) technologies capable of providing early diagnosis, HIV viral load measurements, and CD4 counts in settings where HIV is most prevalent are needed to enable appropriate intervention strategies and ultimately stop transmission of the virus within these populations to achieve the future goal of an AIDS-free generation. This review discusses the available and emerging POC technologies for future application to these unmet public health needs.
    AIDS research and treatment 01/2014; 2014(4):497046. DOI:10.1155/2014/497046
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    • "Similarly to the case made for antiretroviral drugs, if the revised 2010 WHO guidelines are not to remain wishful thinking, a real mobilization for lower prices of reagents and equipment needed to measure viral load is clearly necessary. Technological and logistical challenges linked to viral load testing make its decentralization complex, especially in rural areas and based on previous experience with CD4 counts few years ago, efforts in relation to point-of-care automation, and to maintenance will be key [64,65]. "
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    Journal of the International AIDS Society 08/2012; 15(2):17334. DOI:10.7448/IAS.15.2.17334 · 5.09 Impact Factor
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    • "There is a crucial need for low-cost, simple and accurate HIV-1 viral load monitoring technologies in resource-limited settings, particularly when first- and second-line treatment regimens are scaled up.84,85,86 The Liat HIV Quant Assay (IQuum, Marlborough, MA, USA) is comprised of two components, the Liat Analyzer and the Liat Tube. "
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    ABSTRACT: Substantive and significant advances have been made in the last two decades in the characterization of human immunodeficiency virus (HIV) infections using molecular techniques. These advances include the use of real-time measurements, isothermal amplification, the inclusion of internal quality assurance protocols, device miniaturization and the automation of specimen processing. The result has been a significant increase in the availability of results to a high level of accuracy and quality. Molecular assays are currently widely used for diagnostics, antiretroviral monitoring and drug resistance characterization in developed countries. Simple and cost-effective point-of-care versions are also being vigorously developed with the eventual goal of providing timely healthcare services to patients residing in remote areas and those in resource-constrained countries. In this review, we discuss the evolution of these molecular technologies, not only in the context of the virus, but also in the context of tests focused on human genomics and transcriptomics.
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