Washington, DC - As HIV treatment is scaled up in developing countries, the lack of access to viral load monitoring - routine in wealthy countries - must be addressed. Increased access to viral load monitoring can help people stay on antiretroviral combinations as long as possible, and help stave off resistance, according to a new report released today by the international medical humanitarian organisation Médecins Sans Frontières (MSF). 

Viral load testing is critical for two reasons. First, it identifies people who are having problems regularly taking their medicines, and can be used to trigger additional adherence counselling. Second, it identifies people who have indeed developed drug resistance and need to be switched to another treatment regimen. Viral load testing helps avoid unnecessarily switching patients to more expensive drugs and reducing future treatment options. It also helps identify patients who are taking their drugs but no longer benefiting from a given combination because of resistance.

“It’s time to end the double standard in HIV care between developed and developing countries,” said Dr Eric Goemaere, of MSF in South Africa. “In addition to ensuring people get the medicines they need to stay alive, there is increased urgency to make sure people have access to monitoring. When a person knows their viral load is ‘undetectable,’ it provides motivation to stick to their treatment for the long haul.” 

In developed countries, viral load testing is offered routinely, but because of high cost and tests which are not adapted to resource-limited settings, it is not yet available to most people living in developing countries.

Overcoming complexity and cost barriers

In the report, Undetectable: How Viral Load Monitoring Can Improve HIV Treatment in Developing Countries, MSF outlines a number of currently existing and new viral load technologies that are expected to come to market over the next three years, ranging from point-of-care tests to those that can be used at district laboratory level. The report outlines ideas for overcoming complexity and cost barriers.

MSF has recently field tested one point-of-care viral load device and has also received a grant from the funder UNITAID to field test several current and new viral load technologies over the next three years as a way to help overcome the critical shortfall in viral load capacity in Africa. The new approaches will be tried in seven African countries where the organisation runs HIV treatment programs.

The goal of the project is to determine which new strategies and products are best suited to resource-limited settings. There will be projects that pilot new point-of-care-tests and projects that look at using existing technologies in new ways.  

“We have fought in every single one of our projects to simplify treatment as much as possible to reduce the burden on patients and the health system,” said Teri Roberts, Diagnostics Advisor for MSF’s Access Campaign. “But we came to the conclusion that viral load is an essential tool that extends patients’ lives and helps prevent HIV transmission.”

Living a normal life with 'undetectable' viral load

Viral load testing measures the amount of HIV in a person’s blood; when there are less than 50 copies of HIV’s genetic material per milliliter of blood, a person’s viral load is said to be ‘undetectable.’ This means the virus has been suppressed to a level where a person can live a healthy life and is also much less likely to transmit the virus.  

The tool primarily used for HIV monitoring in developing countries today is a measurement of people’s CD4 white blood cell count, which does not paint an accurate enough picture of how a person is responding to treatment. Viral load testing identifies problems earlier than measuring CD4 count.  

In MSF’s project in Khayelitsha, South Africa, where routine viral load testing is available, people who were identified with ‘detectable’ viral load were given targeted counselling support to improve their adherence to treatment. Three months later at their next check-up, 71 per cent of these patients had an undetectable viral load.

“I am proud that my viral load is undetectable, and I tell others about it,” said Fanelwa Gwashu, who receives treatment through MSF in Khayelitsha, South Africa.  “Antiretroviral treatment is life-long so it’s encouraging to be told that the treatment is working well for me. It helps to know that whatever the difficulties, I am controlling the virus. It helps me plan for tomorrow and I am confident I will live a normal life in the future.”