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1 January 2007

Volume 44, Number 1
Clinical Infectious Diseases 2007;44:128–134
© 2006 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2007/4401-0022$15.00
DOI: 10.1086/510073
HIV/AIDS VIEWPOINTS

HIV Viral Load Monitoring in Resource‐Limited Regions: Optional or Necessary?

Alexandra Calmy,1,5

Nathan Ford,6

Bernard Hirschel,2

Steven J. Reynolds,7

Lut Lynen,4

Eric Goemaere,8

Felipe Garcia de la Vega,1

Luc Perrin,3 and

William Rodriguez9,10

1Médecins sans Frontières, Access to Medicines Campaign, and 2Department of Infectious Diseases/HIV and 3Laboratory of Virology, Division of Infectious Diseases, Geneva University Hospital, Geneva, Switzerland; 4HIV/STD Unit, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; 5St. Vincent’s Hospital, Sydney, Australia; 6Médecins Sans Frontières, Bangkok, Thailand; 7National Institute of Allergy and Infectious Disease International Center of Excellence in Research, Kampala, Uganda; 8Médecins Sans Frontières, Khayelitsha, South Africa; and 9Clinton Foundation HIV/AIDS Initiative and 10Harvard Medical School, Boston, Massachusetts

Although it is a standard practice in high‐income countries, determination of the human immunodeficiency virus (HIV) load is not recommended in developing countries because of the costs and technical constraints. As more and more countries establish capacity to provide second‐line therapy, and as costs and technological constraints associated with viral load testing decrease, the question of whether determination of the viral load is necessary deserves attention. Viral load testing could increase in importance as a guide for clinical decisions on when to switch to second‐line treatment and on how to optimize the duration of the first‐line treatment regimen. In addition, the viral load is a particularly useful tool for monitoring adherence to treatment, performing sentinel surveillance, and diagnosing HIV infection in children aged <18 months. Rather than considering viral load data to be an unaffordable luxury, efforts should be made to ensure that viral load testing becomes affordable, simple, and easy to use in resource‐limited settings.

Received 30 June 2006; accepted 30 August 2006; electronically published 28 November 2006.

  • (See the brief report by Bagchi et al. on pages 135–8 and the editorial commentary by Schooley on pages 139–40)

Reprints or correspondence: Dr. Alexandra Calmy, Médecins Sans Frontières, Access to Medicines Campaign, rue Lausanne 78, CP 116, 1211 Geneva 21, Switzerland ().

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