New era makes viral-load testing an important tool.

With the approval of the first viral-load test, Roche Amplicor HIV-1 Monitor, patients should have a basic understanding of its use before they are tested. The viral-load test measures the amount of HIV RNA in the blood. The viral-load test reflects what the virus is doing in the body and is continually used in clinical research as a key indicator in assessing the progression of HIV disease. Guidelines have been developed that suggest that if a viral load is greater than 30,000 to 50,000 copies, treatment should be considered, regardless of CD4 count. With a viral load of greater than 5,000 to 10,000 copies and CD4 counts or clinical symptoms that suggest HIV is progressing, the guidelines recommend treatment. The aim of the treatment is to reduce viral load to below 5,000 copies. In studies using a three-drug combination that includes a protease inhibitor, patients have been able to reduce their viral loads to undetectable levels for a year or more. To monitor treatment, the guidelines suggest having a viral load test 3 to 4 weeks after therapy begins. Guidelines developed by the Roche test manufacturer, Roche Diagnostic Systems of Branchburg, NJ, suggest having CD4 counts tested whenever viral load is measured in order to obtain insurance coverage and make the best treatment decisions.