The measurement of HIV-1 viral load in resource-limited settings: how and where? Clin Lab 53(3-4):135-148
Centre MURAZ, Wagadugu, Centre, Burkina Faso Clinical laboratory
(Impact Factor: 1.13).
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.
Available from: Mohan Kumar Haleyur Giri Setty
- "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 . Similar assays may also be beneficial in resource-limited settings to monitor antiretroviral therapy (ART) effectiveness and the potential need to switch therapy . 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.
Available from: ncbi.nlm.nih.gov
- "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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ABSTRACT: Many successes have been achieved in HIV care in low- and middle-income countries (LMIC): increased number of HIV-infected individuals receiving antiretroviral treatment (ART), wide decentralization, reduction in morbidity and mortality and accessibility to cheapest drugs. However, these successes should not hide existing failures and difficulties. In this paper, we underline several key challenges. First, ensure long-term financing, increase available resources, in order to meet the increasing needs, and redistribute the overall budget in a concerted way amongst donors. Second, increase ART coverage and treat the many eligible patients who have not yet started ART. Competition amongst countries is expected to become a strong driving force in encouraging the least efficient to join better performing countries. Third, decrease early mortality on ART, by improving access to prevention, case-finding and treatment of tuberculosis and invasive bacterial diseases and by getting people to start ART much earlier. Fourth, move on from WHO 2006 to WHO 2010 guidelines. Raising the cut-off point for starting ART to 350 CD4/mm(3) needs changing paradigm, adopting opt-out approach, facilitating pro-active testing, facilitating task shifting and increasing staff recruitments. Phasing out stavudine needs acting for a drastic reduction in the costs of other drugs. Scaling up routine viral load needs a mobilization for lower prices of reagents and equipments, as well as efforts in relation to point-of-care automation and to maintenance. The latter is a key step to boost the utilization of second-line regimens, which are currently dramatically under prescribed. Finally, other challenges are to reduce lost-to-follow-up rates; manage lifelong treatment and care for long-term morbidity, including drug toxicity, residual AIDS and HIV-non-AIDS morbidity and aging-related morbidity; and be able to face unforeseen events such as socio-political and military crisis. An old African proverb states that the growth of a deep-rooted tree cannot be stopped. Our tree is well rooted in existing field experience and is, therefore, expected to grow. In order for us to let it grow, long-term cost-effectiveness approach and life-saving evidence-based programming should replace short-term budgeting approach.
Available from: PubMed Central
- "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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