Role of HIV-1 Viral Load in Initiating Antiretroviral Therapy

Purpose: For commencement of Antiretroviral Therapy (ART), CD4 count and/or WHO clinical staging is used as the guide in India. In western countries along with clinical and immunological criteria, HIV-1 viral load is also used to start the patient on treatment. The present study was conducted to determine the role of viral load in taking decision on ART commencement in HIV-1 infected treatment naïve individuals. Method: A cross sectional study was carried out at the Integrated Counseling and Testing Centre (ICTC) in the Department of Microbiology at a Tertiary care teaching hospital after Institutional Ethics Committee approval. After obtaining written informed consent, HIV-1 infected patients who were clinically asymptomatic, ART naïve, having CD4 count <250 cells/mm3 and age more than or equal to 15 yrs were enrolled in this study. Blood sample was collected and viral load was estimated by COBAS® TaqMan® HIV-1 Test. Result: During the study period of one year, 8966 HIV-1 infected patients were referred for CD4 count estimation. Of these 1624 patients had CD4 count <250 cells/mm3 and 405 patients were treatment naïve. Of these 96 (23.70%) patients were clinically asymptomatic and were enrolled. Of those enrolled, ten (10.41%) had viral load less than 5000 copies/ml. Conclusion: Decision to start patient on ART can be made judiciously when viral load is used along with CD4 count estimation.