Challenges and opportunities for the implementation of virological testing in resource-limited settings
Challenges and opportunities for the implementation of virological testing in resource-limited settings
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DOI：
10.7448/ias.15.2.17324
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发表时间：
2012-10-09
影响因子：
6
通讯作者：
Ford, Nathan
中科院分区：
文献类型：
--
作者：
Roberts, Teri;Bygrave, Helen;Ford, Nathan
虽然对接受抗逆转录病毒治疗的患者进行常规病毒学监测的优点已经确立，但费用和复杂性限制了其充分实施。监测对于在耐药突变发生之前早期诊断病毒学失败以及触发早期依从性干预非常重要。简单和具有成本效益的病毒载量测试有助于简化和分散测试和战略，例如使用干血斑和混合样本测试，这进一步有助于简化，这些测试和战略正在变得可用。此外，在非病毒血症患者中以分阶段的方式用病毒学监测取代免疫学监测将降低与双重免疫病毒学监测相关的成本。展望未来，简化检测，配合降价策略，允许多个制造商之间的健康竞争，将使病毒载量检测在资源匮乏的环境中得以实施。重要的是，未来的艾滋病毒和艾滋病治疗准则必须为常规病毒学监测提供明确的建议，各国政府和捐助者必须以全面的方式资助实施准确和经实践证明的检测平台。
Though the advantages of routine virological monitoring for patients on anti-retroviral therapy have been established, cost and complexity limit its full implementation. Monitoring is important for diagnosing virological failure early on, before the development of drug resistance mutations, and to trigger early adherence interventions. Simple and cost-effective viral load tests that facilitate simplification and decentralization of testing and strategies, such as the use of dried blood spots and pooled sample testing, which further aid simplification, are becoming available. In addition, replacing immunological monitoring with virological monitoring in non-viremic patients in a phased manner will reduce the costs associated with dual immuno-virological monitoring. Going forward, the simplification of testing paired with price reducing strategies that will allow for healthy competition between multiple manufacturers will enable the implementation of viral load testing in resource-poor settings. It is important that future HIV and AIDS treatment guidelines provide clear recommendations for routine virological monitoring and that governments and donors fund the implementation of accurate and operationally proven testing platforms in a comprehensive manner.