Viral load is the single most important predictor of CD4 cell loss among people in South Africa who had not started HIV treatment, investigators report in PLOS ONE. All the study participants were living with HIV subtype C. The annual decline in CD4 count was approximately 11% for people with a baseline viral load below 10,000 copies/ml, compared to a 14% loss for people with a baseline viral load above 100,000 copies/ml.
The study also found that 22% of people had baseline viral load above 100,000 copies/ml and were thus at high risk of transmitting HIV, yet were not eligible for HIV treatment. The study suggests that a substantial minority of people diagnosed with high CD4 cell counts might spend a long period not taking treatment, despite very high viral load, if national treatment guidelines do not recommend treatment at a CD4 cell count below 500 cells/mm3, or treatment for anyone in a serodiscordant relationship.
The investigators suggest their findings have implications for patient care and HIV prevention. “Our data clearly shows the important prognostic role of a viral load estimate at entry into care.” They also believe their findings support “calls for consideration for the inclusion of viral load estimates at HIV diagnosis to identify those likely to be efficient transmitters of HIV.”
It is well known that a higher viral load is associated with accelerated CD4 cell loss. However, less is known about viral load and CD4 cell dynamics among people in resource-limited settings, where different HIV subtypes may be an important factor.
Researchers therefore designed a study monitoring CD4 count changes and their relationship to baseline viral load among people living with HIV subtype C in South Africa.
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