The three biggest myths about viral load monitoring in resource-limited settings

Through my work I’ve understood that there are many different perspectives on viral load monitoring (VLM). All of them are understandably products of their environment. Many of the beliefs people have regarding viral load monitoring were formed over a decade ago when there were only RNA-based HIV viral load testing platforms available.  In 2002 a new platform based on reverse transcriptase (RT) was introduced that made viral load monitoring more accessible without sacrificing reliability.

To those of you who are familiar with both platforms these myths may sound quite out of step with the times. But these opinions are widely held in many parts of the world, particularly in those parts of the world defined as resource-limited.

1. You don’t need viral load monitoring when you have CD4 testing
   HIV viral load tests and CD4 tests measure different things (see: What’s the difference between HIV viral load tests and CD4 tests). CD4 is an excellent test to see what condition the immune system is in. Viral load, on the other hand, detects how active the HIV virus is. Both these pieces of information are important for doctors to use when managing HIV.  That’s why in most developed nations, both tests are given as a routine part of HIV management.
2. Viral load monitoring is too expensive
   This was the impression made when viral load testing was introduced into Sub-Saharan Africa in the 1990’s.  The costs of the tests and equipment have come down significantly since then but the perception remains.  What people often fail to consider is the cost of not testing. A recent study(1) has suggested that frequent viral load and CD4 monitoring has the potential not only to add three quality-adjusted life years to patients’ lives, but save billions of dollars for struggling economies in Africa and elsewhere.
3. Viral load monitoring is impractical for resource-limited regions
   RNA-based platforms introduced in the 1990’s required delicate instruments and advanced laboratory conditions that are rare to find in resource limited settings. That all changed in 2002 when tests using reverse transcriptase (RT) as a marker where introduced. Today there is a test that can work in the resource limited settings but in many instances this perception remains an obstacle.

1. Vijayaraghavan A et al. Cost effectiveness of alternative strategies for initiating and monitoring highly active antiretroviral therapy in the developing world. Journal of Acquired Immune Deficiency Syndrome. 2007 Sept 1;46(1):91-100.

Comments

[Sara]

Are RT tests available in resource limited settings?