About My Health Careers Internship MedBlogs Contact us
Medindia LOGIN REGISTER
Advertisement

Viral Load in HIV Patients Determines Response to Treatment

by Julia Samuel on January 3, 2018 at 3:39 PM
Font : A-A+

Viral Load in HIV Patients Determines Response to Treatment

Antiretroviral treatment (ART) for HIV-positive patients sometimes is a failure. Scientists find that low-level viraemia (LLV) is an important risk factor for treatment failure. Viraemia is a medical condition where viruses enter the bloodstream and thus have access to the rest of the body.

The findings indicate that the current World Health Organization (WHO)-defined threshold for virological failure does not identify a large subset of patients who are at increased risk of poor outcomes of ART. Thus, clinical intervention should take place at lower viral loads than those proposed by the current WHO guidelines. Viral load refers to the amount of HIV virus in the blood.

Advertisement


A team of scientists including Dr Sergio Carmona from the University of the Witwatersrand, Johannesburg and the National Health Laboratory Service; the Ndlovu Research Consortium in Limpopo Province; the University of California San Diego, USA; and the University Medical Center Utrecht in the Netherlands, published the study in Lancet Infectious Diseases.

Carmona, in the division of Molecular Medicine and Haematology, School of Pathology at Wits University and Head of the Viral Load Unit at the National Health Laboratory Service, says: "This study provides clear evidence that clinical interventions should take place at lower viral loads than those proposed by the current WHO guidelines. We need to support the scale-up of viral load testing in low and middle-income countries as well as encourage adherence to ARVs and close follow-up of viral load results."
Advertisement

WHO Guidelines on Viral Load

The monumental response to the global HIV epidemic has led to an unprecedented number of patients on ART. The goal of ART in HIV positive patients is to suppress the viral load. From the start of the ART roll-out, South Africa has invested in laboratory capacity to enable routine viral load monitoring of all patients on ART.

The implementation of viral load monitoring was done largely in accordance with WHO ART guidelines, which advises annual routine monitoring, and a threshold of 1000 copies/mL to define virological failure.

In clinical guidelines for high-income settings, cut-offs for therapy failure are lower, and clinical intervention is already required above 50 copies/mL. Suppression below 50 copies prevents disease progression towards AIDS (Acquired Immune Deficiency Syndrome - the result of untreated HIV infection), prevents selection of resistance, and lowers the risk of transmission of the virus to others.

The South African large-scale viral load monitoring programme yields unique insights into crucial aspects of WHO ART guidelines, such as the WHO's current definition of virological failure.

Risk of Treatment Failure in HIV Patients

The study of over 70 000 patients attending 57 HIV treatment facilities has shown that patients presenting with detectable viral loads below the lenient 1000 copies/mL threshold are at an increased risk to develop virological failure - i.e. less than 1000 copies/mL.

A quarter of the patients in this cohort, who were on first-line ART, experienced one or more episodes of LLV. Compared to patients with virological suppression, that is with less than 50 copies/ml, patients with LLV were threefold more prone to develop failure of ART. In patients with LLV of the highest range (400-999 copies/mL) this risk increased to nearly fivefold. The risk to change to second-line therapy was even more pronounced to 13 times.

Important conclusions can be drawn from this study. The findings indicate that the current WHO-defined threshold for virological failure fails to identify a large subset of patients who are at an increased risk of poor outcomes of ART.

A more active approach to low-level viremia is essential to prevent virological failure and subsequent selection of resistance. Such an approach should be implemented prior the introduction of integrase inhibitors which are the cornerstone of ART globally to preserve this powerful treatment for the coming decades.

"Sustainable virological suppression is an important part of the 90-90-90 targets defined by UNAIDS. This study shows that patients with low-level viraemia are at risk for therapy failure. A strong message from WHO regarding the risk of virological failure after LLV could motivate clinicians to act when LLV is encountered," says Professor Francois Venter, deputy executive director, Wits Reproductive Health and HIV Institute (Wits RHI).

90-90-90 refers to 90% of all people living with HIV knowing their status by 2020, 90% of those diagnosed be receiving ART bu 2020, and 90% of those on ART will have viral suppression by 2020.

Source: Eurekalert
Advertisement

Advertisement
News A-Z
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
Advertisement
News Category
What's New on Medindia
Turmeric: Magic Ingredient to Keep you Healthy in Winter
Top 7 Benefits of Good Oral Hygiene
Healthy and Safer Thanksgiving 2021
View all

Medindia Newsletters Subscribe to our Free Newsletters!
Terms & Conditions and Privacy Policy.

More News on:
Oral Health And AIDS AIDS/HIV AIDS/HIV - Epidemiology AIDS/HIV - Clinical Features AIDS/HIV - Health Education AIDS/HIV - Prevention And Transmission AIDS / HIV - Treatment AIDS/HIV- Lab Tests and Faqs Prostitution: Fresh Stakes in the Oldest Trade HIV Symptom 

Recommended Reading
Antiretroviral Therapy for HIV Treatment
Antiretroviral therapy for HIV treatment helps to restore the functions of the immune system and ......
AIDS/HIV
"AIDS is an epidemic disease, a potentially preventable, deadly infection for which there is no ......
AIDS / HIV - Treatment
Encyclopedia section of medindia explains in brief about the treatment for AIDS/HIV...
AIDS/HIV - Clinical Features
Encyclopedia section of medindia gives general info about HIV Clinical Features...
AIDS/HIV - Epidemiology
AIDS or HIV is an epidemic disease, a potentially deadly infection that can be prevented with preca...
AIDS/HIV - Health Education
Encyclopedia section of medindia gives general info about AIDS information and health education....
AIDS/HIV - Prevention And Transmission
Encyclopedia section of medindia explains in brief about the prevention for AIDS/HIV...
Oral Health And AIDS
AIDS has taken on massive proportions in modern times. It is estimated that over 15 million people a...
Prostitution: Fresh Stakes in the Oldest Trade
Prostitution has broadened its base to include street prostitution, massage brothels, gigolo outcall...

Disclaimer - All information and content on this site are for information and educational purposes only. The information should not be used for either diagnosis or treatment or both for any health related problem or disease. Always seek the advice of a qualified physician for medical diagnosis and treatment. Full Disclaimer

© All Rights Reserved 1997 - 2021

This site uses cookies to deliver our services. By using our site, you acknowledge that you have read and understand our Cookie Policy, Privacy Policy, and our Terms of Use