Update on HIV patient management: latest trends in laboratory testing, immune cell reconstitution, and vaccine development.
HIV patient management requires the close interaction of clinicians and laboratorians to integrate the results obtained by emerging methodologies. Evaluation of drug susceptibility to screen for specific mutations in the HIV genome can avoid needless treatment with ineffective drugs, maximizing the benefits of costly triple-drug therapy. In addition, providing a scientific basis for the effective use of genotyping and therapeutic drug monitoring is a valuable role that laboratorians can play in optimizing patient care. The clinical utility of HIV genotyping has been defined more clearly during the last year, and pharmacokinetic profiles of the antiretrovirals are beginning to emerge in the clinical laboratory as a tool to periodically assess adherence to and efficacy of the drug regimens. However, much more work is required in this area. Switching to simpler regimens is perceived as a means to improve medication adherence, manage drug toxicity, and reduce the potential for interaction among different drugs. HIV affects the function of both cytotoxic T-cells and neutralizing antibodies. The ability to identify and quantify HIV-specific immunity may allow us to target and expand specific deficient cell clones as a means of correcting immune deficiencies and strengthening the effects of drug therapy. One such example is IL-2, shown to increase CD4 cell counts at various stages of HIV disease. Additional studies of IL-2 therapy and newer immune modulators are ongoing. Combination vaccines are being tested as a worthwhile approach to optimize induction of both CTLs and antibodies. The role of the laboratory to determine the potency of HIV vaccine candidates awaits further developments evaluating the relative importance of neutralizing and mucosal antibodies versus CTL responses and the degree of immunogenicity needed to contain the spread of infection. The Center for Disease Control and Prevention aims to reduce new HIV infections by 50% per year in the next five years, and this goal is to be achieved through selected strategies put together by the plethora of experts in this arena. The aim of this article is to update the reader on the latest trends in HIV patient management and motivate collaborations to assist in the prompt implementation of improved medical care.
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Millennium Strategies, Madison, WI 53717, USA. PamelaBean@home.com