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Ending the AIDS epidemic by 2030 will require decentralised models that expand access to HIV viral load testing and support prompt initiation of treatment. In order to have a point of care test for checking HIV viral load (VL), ICMR-National Institute of Translational Virology and AIDS Research in Pune recently undertook research, in association with National AIDS Control Organization (NACO).
Viral load in HIV, according to experts, is the measurement of the amount of HIV virus in a person’s blood and study researchers looked at whether the GeneXpert machine can be used for the HIV VL test with plasma samples. These machines are already used for TB testing at district and sub-district levels under the National TB Elimination Programme. The study also examined if dried blood spot (DBS) samples could be used for HIV VL testing at national reference labs since transporting plasma is difficult.
Dr Suchit Kamble, Scientist F and Principal Investigator of the study told The Indian Express that HIV VL testing using plasma samples on GeneXpert platform or DBS based HIV VL testing on the Abbott platform is found to be feasible.
Ahead of World AIDS Day (December 1), findings of this study assume importance as evidence of this kind can enable the programme to advance more rapidly towards the global objective of achieving viral suppression among 95 per cent of people living with HIV on ART.
High HIV viral load would mean that the virus is making more copies of itself in the body. Dr Kamble explained that a viral load below 1000 copies/ml (as per NACO) indicates that antiretroviral therapy is working well to control the virus. Suppressed HIV viral load reduces risk of HIV transmission significantly to other partner.
Currently people living with HIV and on antiretroviral treatment (ART) are monitored by conducting routine HIV Viral load (VL) tests based on plasma samples. In order to conduct these tests NACO has been continuously expanding a network of sophisticated laboratories. Presently there is a network of 80 HIV VL testing reference laboratories under the National AIDS Control Program to which more than 760 ART centers are linked.
Plasma samples are transported to these specialised laboratories where HIV VL tests are performed on Abbott platform by trained laboratory personnel. On an average 10-12 days are required to get these test results mainly due to transportation time and burden of testing samples. Hence there is also a need to have a point of care for HIV VL test and the study explored the feasibility of using the GeneXpert platform for HIV VL test based on plasma samples.
According to Dr Manisha Ghate, Scientist G at NITVAR, adoption of either of these approaches through decentralised HIV VL testing will help in early diagnoses of virological failure. She also highlighted that adoption of this strategy may lead to prompt changes in individual persons living with HIV care, due to improved access to VL testing and timely shifts to second- or third-line ART, as per requirement both in urban and rural areas.
Dr Sheela Godbole, Director, ICMR-NITVAR also pointed out that evidence like this can help the programme move faster towards the global target of achieving viral suppression among 95% of people living with HIV on ART.
