Plasma viral load testing in the management of HIV infection

The polymerase chain reaction assay, branched DNA assay and nucleic acid se quence-based amplification assay quantitate human immunodeficiency virus (H IV) RNA revels. Plasma viral load (PVL) testing has become a cornerstone of HIV disease management. Initiation of antiretroviral drug therapy is usual ly recommended when the PVL is 10,000 to 30,000 copies per mt or when CD4T-lymphocyte counts are less than 350 to 500 per mm(3) (0.35 to 0.50 x 10(9 ) per L). PVL levers usually show a 1- to 2-log reduction within four to si x weeks after therapy is started. The goal is no detectable virus in 16 to 24 weeks. Periodic monitoring of PVL is important to promptly identify trea tment failure. When feasible, the same assay should be used for serial PVL testing in the individual patient. At least two PVL measurements usually sh ould be performed before antiretroviral drug therapy is initiated or change d. PVL testing may be helpful in the rare instance of indeterminate HIV ant ibody testing, especially in a patient with recent infection.