A large cohort study in South Africa has revealed that that low-level viraemia (LLV) in HIV-positive patients who are receiving antiretroviral treatment (ART) is an important risk factor for treatment failure.
Viraemia is a medical condition where viruses enter the bloodstream and thus have access to the rest of the body.
The findings indicate that the current World Health Organization (WHO)-defined threshold for virological failure does not identify a large subset of patients who are at increased risk of poor outcomes of ART. Thus, clinical intervention should take place at lower viral loads than those proposed by the current WHO guidelines.
Viral load refers to the amount of HIV virus in the blood.
A team of scientists including Dr Sergio Carmona from the University of the Witwatersrand, Johannesburg and the National Health Laboratory Service; the Ndlovu Research Consortium in Limpopo Province; the University of California San Diego, USA; and the University Medical Center Utrecht in the Netherlands, published the study in Lancet Infectious Diseases in November 2017.
Dr Sergio Carmona, in the division of Molecular Medicine and Haematology, School of Pathology at Wits University and Head of the Viral Load Unit at the National Health Laboratory Service, says: “This study provides clear evidence that clinical interventions should take place at lower viral loads than those proposed by the current WHO guidelines. We need to support the scale-up of viral load testing in low and middle-income countries as well as encourage adherence to ARVs and close follow-up of viral load results.”