Ehiv Rna levels

1. Quantitation of plasma HIV RNA (viral load), a marker of the rate of viral replication, is useful in determining prognosis. It is used to estimate the risk of disease progression and to aid in making antiretroviral therapy decisions.

2. HIV RNA levels generally vary no more than 0.3 log in clinically stable patients. Sustained changes greater than threefold (0.5 log) are significant. A decrease occurs with successful antiretroviral therapy. A upward trend in a patient not receiving antiretroviral therapy indicates an increase in viral replication. Increases noted during treatment suggest antiretroviral drug failure or poor adherence.

Parameter

Recommendation

Target level of HIV RNA after initiation of treatment

Undetectable; <5,000 copies/mL

Parameter

Recommendation

Minimal decrease in HIV RNA indicative of antiretroviral activity

>0.5 log decrease

Change in HIV RNA that suggests drug treatment failure

Rise in HIV RNA level

Failure to achieve desired reduction in

HIV RNA level

Suggested frequency of HIV RNA measurement

At baseline: 2 measurements, 2-4 wk apart.

3-4 wk after initiating or changing therapy

Every 3-4 mo in conjunction with CD4+ counts

3. HIV RNA levels should be obtained before the initiation or change of antiretroviral therapy. The next determination should be done a month after therapeutic intervention to assess its effect and then every 3 or 4 months.

4. Quantitative HIV RNA assays include branched DNA (bDNA) (Multiplex) and reverse transcriptase-initiated polymerase chain reaction (RT-PCR) (Amplicor HIV-1 Monitor). While both tests provide similar information, concentrations of HIV RNA obtained with the RT-PCR test are about twofold higher than those obtained by the bDNA method. For this reason, all HIV RNA determinations in a single patient should be obtained using the same assay.

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