Use of laboratory-developed assays in global HIV-1 treatment-monitoring and research

Abstract

There has been a surge in the emergence of HIV-1 drug resistance in Low and Middle-Income Countries (LMICs) due to poor drug-adherence and limited access to viral load testing, the current standard for treatment-monitoring. It is estimated that only 75% of people living with HIV (PLWH) worldwide have access to viral load testing. In LMICs, this figure is below 50%. In a recent WHO survey in mostly LMICs, 21 out of 30 countries surveyed found HIV-1 first-line pre-treatment drug resistance in over 10% of study participants. In the worst-affected regions, up to 68% of infants born to HIV-1 positive mothers were found to harbour first-line HIV-1 treatment resistance. This is a huge public health concern. Greater access to treatment-monitoring is required in LMICs if the UNAIDS “third 95” targets are to be achieved by 2030. Here, we review the current challenges of viral load testing and present the case for greater utilization of Laboratory-based assays that quantify intracellular HIV-1 RNA and/or DNA to provide broader worldwide access to HIV-1 surveillance, drug-resistance monitoring, and cure-research.

HIV Expression in Infected T Cell Clones

“…These viral DNA population characteristics are reflected in plasma viremia typically being reduced to undetectable levels by standard clinical assays (<50 copies HIV RNA/mL). Yet low-level viremia can usually be detected in PLWH on ART using more sensitive laboratory tests [ 58 ], and clinically detectable, non-suppressible viremia persists for long periods in some individuals [ 59 ]. Moreover, low levels of unspliced intracellular HIV-1 RNA have been detected in variable fractions of clonal infected cell populations across T cell subsets and harboring intact or defective proviruses [ 60 ], indicating that at the population level, viral transcriptional suppression is not always complete.…”

Revolutionizing HIV-1 Viral Load Monitoring in India: The Potential of Dried Blood Spot Analysis for Expanding Access and Improving Care

“…Over the years, concerted efforts have led to a decline in the overall prevalence of HIV. However, India still has one of the largest populations of people living with HIV globally [1,2]. Prevention programs have contributed to decreased transmission rates, but certain groups, such as men who have sex with men, sex workers, and injecting drug users, remain disproportionately affected [3].…”

“…According to the latest report from the NIH, only approximately 77% of people living with HIV (PLHIV) worldwide have access to viral load testing facilities. Furthermore, the report highlights an increase in HIV-1 drug resistance in low and middle-income countries due to poor drug adherence and limited access to viral load testing [1,2]. Resistance to antiretroviral therapy in HIV-1 evolves over time, affecting various drug classes, including the latest generation of inhibitors [4].…”