The measurement of HIV-1 viral load in resource-limited settings: how and where?
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.
Rouet
Francois
F
Laboratoire de Virologie, Centre Muraz, Bobo-Dioulasso, Burkina Faso, West Africa. franrouet@yahoo.fr
Rouzioux
Christine
C
D023241:Antiretroviral Therapy, Highly Active; D003906:Developing Countries; D015750:Genes, gag; D015751:Genes, pol; D014644:Genetic Variation; D016655:HIV Core Protein p24 / Q000097:blood; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1 / Q000145:classification / Q000187:drug effects / Q000235:genetics / Q000502:physiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012367:RNA, Viral / Q000097:blood; D011933:Reagent Kits, Diagnostic; D012015:Reference Standards; D015203:Reproducibility of Results; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012680:Sensitivity and Specificity; D020079:Terminal Repeat Sequences; D019562:Viral Load / Q000191:economics* / Q000379:methods*
D016655:HIV Core Protein p24; D012367:RNA, Viral; D011933:Reagent Kits, Diagnostic