How to Test and Monitor HIV in Developing Countries

The majority of HIV infections are in resource-poor regions of the world, such as Africa, Southeast Asia, and Russia, where few people can afford the US$100-150 for diagnostic testing and disease monitoring. What can be done to help HIV patients there?

Two solutions exist. One is for manufacturing companies to subsidize the cost of the tests on a country-by-country basis. Another way is to develop alternate technologies that give an approximate answer. There has been increasing interest in alternative testing methods, not only because of pricing but also because of the requirements for a ready supply of electricity and the availability of qualified technicians and labs to perform the tests and maintain quality assurance programs.

As a result, some countries are using the heat-denatured p24 antigen test, originally used in the United States and Western Europe before it was surpassed by the viral load and CD4 assays. This test is used as a viral marker and provides an indication of the amount of virus in a patient, although not specific viral copies. The cost is about US$10.00 per test. Another test, known as Quantitative RT-VLA, measures the reverse transcriptase activity in plasma samples from HIV-infected patients. The cost is $20.00 per test.

Alternatives to flow cytometric quantitation of CD4 T-cells are Cyto-Spheres, Dynabeads, and PanLeucogated CD4 T-cell enumeration, used in a number of countries. All of these allow a doctor to make decisions about a patient's clinical state. While they do not provide the exact number of copies of the virus, they do give the doctor and patient an indication of whether treatment should be initiated or modified.

These solutions were presented by Deshratn Asthana, Ph.D., associate professor of medicine and psychiatry at the University of Miami School of Medicine (Miami, USA), who spoke at the annual meeting of the American Association of Clinical Chemistry in Philadelphia (PA, USA).