title: HIV-1 viral diversity and its implications for viral load testing: review of current platforms.
abstract: The 2008 Recommendations for care of the International AIDS Society reaffirmed the importance of both accurate and sensitive viral load assessment, and by necessity, access to viral load assays. HIV-1 viral load testing is considered essential when initiating antiretroviral therapy (ART), when monitoring ART response, and when considering switching ART regimens. The demand for accurate, reproducible, and cost-effective viral load assays is therefore a global issue. Although the North American and Western European experience has historically been with HIV-1 group M subtype B virus, this paradigm is changing rapidly as migrants and refugees from developing countries with non-B subtype infections often now present for care in the developed world, and travelers to developing countries acquire non-B subtype infection abroad and present for care at home. Awareness of any clinical or laboratory differences between the common HIV-1 group M subtype B and the newer HIV-1 strains being seen in practice is therefore increasingly important. This review of current HIV-1 viral load testing is focused on the potential value of a standardized genotype assignment for HIV-1 viral subtypes, regular monitoring of the performance of available commercial HIV viral load assays on emerging non-B HIV subtypes, circulating recombinant forms (CRFs) and unique recombinant forms (URFs), and a discussion of the implications for resource-limited settings.
authors.affiliation: Department of Medicine, University of Calgary, 2500 University Dr. N.W. Calgary, AB, Canada T2N 1N4.
authors.forename: LeeAnne M
authors.initials: LM
authors.lastname: Luft
authors.forename: M John
authors.initials: MJ
authors.lastname: Gill
authors.forename: Deirdre L
authors.initials: DL
authors.lastname: Church
mesh_terms: D014644:Genetic Variation; D005838:Genotype; D015658:HIV Infections / Q000175:diagnosis* / Q000635:transmission; D015497:HIV-1 / Q000145:classification / Q000235:genetics*; D006801:Humans; D019562:Viral Load / Q000379:methods*