Individualisation of HIV therapy based on HIV RNA load: the virologist's perspective

There is increasing evidence that direct quantification of viral load by quantitative HIV RNA polymerase chain reaction (PCR) may be one of the more useful markers of disease status and antiviral treatment efficacy. Given the central role of viral replication in the pathogenesis of HIV infection, it is logical to assume that monitoring levels of cell-free virus in the plasma will be predictive of disease status. Furthermore, since the primary aim of treatment with current antiretroviral therapies is reduction of viral load, changes in plasma viraemia may be expected to be predictive of treatment effects. Preliminary data indeed suggest that viral load, is a useful marker of baseline prognosis, disease status and the effectiveness of antiretroviral therapy in individual patients. These data support the concept that measurement of viral RNA may eventually be of clinical utility in managing therapy of individual patients. However, prospective viral load studies are required to validate such a strategy.