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Perspectives on Viral Load (HIV RNA) and When to Initiate Therapy
Viral load measurements just after sero-conversion
predict disease progression, independent of CD4
Variability of viral load measures
Relationship between disease progression and baseline
RNA levels
A 2 log reduction in RNA is not the same for everyone
When does an individual initiate therapy?
Cautious approach to "new paradigm"
Treatment effects are not totally explained by CD4 and RNA
Guidelines for using viral load testing and interpreting
measurements, as recommended by an advisory panel
to the International AIDS Society (IAS)
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We are entering into a new era for treatment of HIV because of the development of the new class of drugs called protease inhibitors and secondly because of the development of the new technology called viral load testing. On June 3, the FDA granted approval to Roche Diagnostics for their viral load test, AMPLICOR HIV-1 MONITOR test, more commonly known as RT-PCR, viral load or HIV RNA PCR. It is the first test approved by the FDA. Chiron Diagnostic's bDNA test has been submitted to the FDA for consideration. Very recently, two important articles were published about viral load; key information from these articles are addressed here.
One of the two articles present important data from the Pittsburgh portion of MACS (Multi-center AIDS Cohort Study)--"Prognosis in HIV-1 Infection Predicted by the Quantity of Virus in Plasma" (John Mellors et al, May '96); it discusses the correlation between baseline viral load after HIV seroconversion and clinical progression (prognosis)--results say clinical progression can be predicted. The second article--"HIV Viral Load markers in clinical practice" (Mike Saag et al, June '96), discusses the recommended guidelines for using viral load tests by the USA advisory panel to the International AIDS Society (IAS).
First is a reproduction (transcription) of a presentation by Dr. Robert Coombs on viral load: data related to using viral load measures and its correlation to clinical progression (prognosis); how to properly use the tests and interpret their results, and his comments on the IAS recommended guidelines. It is a mixture of direct quotes from his talk and discussion from this author. Dr. Coombs' talk was presented at the National AIDS Treatment Advocacy Project community treatment forum called: "Protease Inhibitors and Viral Load: Current and Future Use". It took place in Los Angeles on April 13, 1996. A limited supply of videotapes are available of the entire 4-hour forum by contacting NATAP.
Also available is NATAP's 46-page bound booklet--"HIV Protease Inhibitors Report-2nd edition", a comprehensive compilation of available data and information for 5 protease inhibitors. Soon after the Vancouver Conference an updated report will be available, in addition to comprehensive coverage of important breaking information from the Conference reported at our NATAP Internet Web-site
Dr. Robert Coombs, MD, PhD, FRCP(C) Departments of Laboratory Medicine and Medicine University of Washington--Seattle, Washington
About the author: Jules Levin is the Executive Director of NATAP, based in New York City.
The National AIDS Treatment Advocacy Project (NATAP) is a New York State non-profit corporation dedicated to facilitating the effort for development of effective treatment for HIV. We advocate on treatment and policy issues for people with HIV and AIDS, with drug companies, researchers, government officials (including the FDA) and other treatment and policy advocates. We are equally committed to disseminating important information about these treatments to concerned people. NATAP is committed to the concept of, at least, making HIV manageable.
For copies of this report, please contact: National AIDS Treatment Advocacy Project, Inc. 72 Orange Street, #3C, Brooklyn, N.Y. 11201 Telephone: 718-624-8541, Fax: 718-624-8399 Internet Treatment Web page address: http://www.aidsnyc.org/natap
Information contained in this report is provided solely as an educational resource. The information is copyrighted by NATAP. This information shall not, in whole or in part, be redistributed, reproduced, or put into a computer without prior verbal or written permission. Every effort was made to ensure the accuracy of the information contained in this report. Being listed in this report in no way implies endorsement of any of the products mentioned herein. Always consult with your professional healthcare provider prior to initiating any treatment regimens.
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About the author: Jules Levin is the Executive Director of NATAP, based in New York City.
The National AIDS Treatment Advocacy Project (NATAP) is a New York State non-profit corporation dedicated to facilitating the effort for development of effective treatment for HIV.
Last modified 9/3/96
by Jules Levin
Copyright © 1996 natap
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