Article

HIV Viral Load Monitoring

The goal of ending HIV/AIDS is realistic.

The HIV/AIDS pandemic continues to be real with approximately 2,110 people dying of AIDS every day in 2018.¹ During the same year, about 37.9 million people were living with HIV, of which about 8.1 million were not even aware that they had the infection.

But this, in fact, is great progress. If we look at the overall numbers over the years, there is a 56% drop in AIDS-related deaths since 2004 and a 33% decline since 2010.¹ New HIV infections have been reduced by 40% since the peak in 1997.²

With the concerted effort from UNAIDS and partnerships with key organizations and businesses, the numbers are actually looking good and the goals of ending AIDS continues to be realistic. Much of this progress can be attributed to improved access to timely diagnosis and monitoring and proper treatment.

HIV cannot be cured but can be kept at bay

HIV attacks the immune system by destroying the cells that impart immunity to the body. Antiretroviral therapy (ART) is commonly used to treat HIV. ART uses a combination of drugs to prevent the virus from replicating and help restore the immune cells lost during infection.

While ART is quite effective, it is not guaranteed that everyone will respond to therapy. Therefore, it is important to monitor the response to see if the treatment continues to be effective. This can be done effectively by measuring and monitoring the viral load.

What is viral load and what does it mean?

Viral load is the amount of HIV circulating in the blood stream. The goal of ART is viral load suppression to the extent that it is brought to and maintained at undetectable levels.

A low viral load indicates that the treatment is working and is effective. A high viral load, on the other hand, suggests that the virus is becoming resistant to therapy or that the treatment is not being followed rigorously.

Research has shown that HIV can persist after years of aggressive drug treatment and can hide in the gut tissue.² But at a very low level the virus can neither harm the patient nor infect others.

Ideally the therapy should achieve an undetectable viral load. In order to measure viral loads, we need diagnostic assays that have high sensitivity.

How does monitoring viral load contribute to the goal of ending HIV?

Monitoring HIV levels is a standard procedure in treating HIV-infected patients in high-income countries. Unfortunately in low and middle-income countries with a significant HIV presence,³ viral load monitoring is still not a recommended option due to its high cost and limited accessibility.

To attain the 90-90-90 end goal, 90% of people living with HIV should be able to know their HIV status, 90% of people who know their HIV status should have access to high-quality HIV treatment options and 90% of people should have attained viral suppression. The fact that we still have new infections means that diagnosis and treatment have still not reached all the affected people.

UNAIDS therefore deems that ensuring ready access to viral load testing for those receiving antiretroviral therapy is essential for achieving the 90-90-90 target by 2020.³ Viral load testing also helps prevent unnecessary changes to mediation (often to more expensive medicines) or continuing on medications that are no longer effective, which can result in drug resistance and even untimely death.⁴

What does Roche do to help patients know their viral load status?

The key is access to diagnosis and treatment, and testing is needed to identify those who need treatment and to monitor the response to therapy.. But accessibility to and affordability of diagnostic tests are still major constraints. Patients in several parts of the world are still unable to reach diagnostic sites. Even if they have access to these diagnostic sites, many can’t afford to get tested.

To address this, Roche has launched its Global Access Program to expand HIV diagnostics to where it is most needed.

In the Global Access Program, we collaborate with partner organizations, governments and relief organizations worldwide improving access to highly sensitive diagnostic assays that can quantitate HIV viral loads for people who need it the most around the world.

We introduced early infant HIV diagnostics to the program in 2015. Our dedication to stamping out AIDS has led to a total of 1.5 million infant diagnosis tests using Roche assays in 2015. In 2016, we incorporated the newest automated systems to extend our reach to more communities in need.

What does the future hold for HIV/AIDS?

The concerted effort of all the partners and UNAIDS is paying off. The world is tantalizingly near achieving the 90-90-90 target set for 2020.

Here is where we stood as of 2018:

With continued and easy access to early infant diagnosis and viral load testing for every patient receiving ART in every part of the world, however remote it is, we can feasibly bring an end to the HIV pandemic. Attaining the 90-90-90 goal is still realistic!

References

Global HIV &AIDS statists – 2019 fact sheet. Calculated from: https://www.unaids.org/en/resources/fact-sheet
Chun TW et al. Persistence of HIV in gut-associated lymphoid tissue despite long-term antiretroviral therapy. J Infect Dis. 2008. 197; 5:714-20.
World Health Organization. HIV/AIDS. Data and statistics. Accessed, November, 2019.
UNAIDS 2016. The need for routine viral load testing. https://www.unaids.org/sites/default/files/media_asset/JC2845_en.pdf