Viral load should be used in less developed settings to monitor treatment in children with HIV

A measure of HIV genetic material in the blood, or viral load, is the most accurate predictor of the occurrence of serious HIV-related illnesses in children being treated for HIV in less developed countries, according to findings from an NIH study conducted throughout Latin America.

Viral load is a barometer for the efficacy of HIV treatment, with high viral loads indicating potential treatment failure, which may lead to a weakened immune system and increased risk for infections.

Although monitoring children’s viral load is standard in the United States, the technology to perform viral load testing is difficult and expensive to maintain and, therefore, often unavailable in less developed settings.

Typically, clinical symptoms or immune cell number are used to monitor the effectiveness of therapy in less developed settings. Therefore, researchers assessed the value of adding viral load as a measure for children receiving anti-HIV treatment in an underdeveloped setting.

Shipping blood samples to a central facility that could measure viral loads may provide a cost-effective alternative to performing viral load measurements at each clinical care site in resource poor settings, according to the researchers.

“Our study showed that adding viral load monitoring would significantly improve the monitoring regimen used to safeguard the health of children being treated for HIV,” George K. Siberry, MD, MPH, medical officer in the Pediatric, Adolescent and Maternal AIDS Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, said in a press release.

The researchers analyzed the medical records of 600 children with HIV who were receiving treatment at hospitals in Brazil, Mexico and Peru. Participants were aged younger than 15 years and had been on anti-HIV medication for at least 6 months.

Children’s viral load levels were monitored every 6 months. Counts of CD4 white blood cells and oxygen-carrying molecules in red blood cells were also measured, along with the children’s growth and development.

The researchers aimed to determine whether the most recent measurements of viral load could predict serious HIV-related illnesses, classified by WHO as stage III and IV events. They evaluated the predictive value of 400 copies of viral genetic material per milliliter of blood and 5,000 copies/mL of blood.

Findings demonstrated that a viral load of 5,000 copies/mL predicted an elevated risk for serious illness in children on HIV treatment, providing clinical evidence for a new WHO recommendation to change HIV medications when it seems that treatment is failing, according to the researchers.

At more than 5,000 copies/mL of blood, the risk for developing a WHO stage III or IV event was nearly doubled, independent of CD4 cell and hemoglobin levels and BMI. A combination of all three measurements most accurately predicted potential future illness, according to the researchers.

The researchers said using dried blood spots for viral load testing may provide a cost-effective alternative to routine viral load testing methods. They cited findings from previous studies showing that blood spots could be readily used to detect viral load at the level that predicted clinical illness in the current study.

Filter paper, similar to what is used for newborn screening programs in the United States, could be used to collect blood samples in remote or poor areas and shipped to a central facility where they could be processed reliably and economically, the researchers said.

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