In 2013, the Human Immunodeficiency Virus (HIV) testing guidelines released by the World Health Organisation (WHO) said that patients undergoing Anti-retroviral treatment (ART) must undergo two important tests- viral load and CD4 count test. While the viral load test counts the numbers of HIV virus particles in the blood, the CD4 cell count test counts the numbers of T cells which provide immunity against infections.
According to doctors, the treatment of patients in India undergoing first line ART at National Aids Control Organsation (NACO) supported centres continues to be monitored, only on the basis of the CD4 test count. Doctors said that the CD4 test by itself is an unreliable indicator of measuring the success or failure of ART.
“When the treatment fails, the virus load in the body increases and the CD4 count decreases gradually and not immediately,” said a doctor who works with the WHO. “If we rely just on the CD4 count results, it may be misleading and would lead to believe that the treatment is working fine, when in fact it is not,” he added.
Dr Srikala Acharya, additional project director of Maharashtra District Aids Control Society- a body that implements the National Aids Control Programme, said that at present only patients who are on second and third line ART treatment, are tested for viral load. “We are just following the NACO guidelines. We do viral load testing for patients on first line only if we clinically see their condition deteriorate,” she said.
According to a NACO official who did not wish to be named, the organisation has already received a grant from the Global Fund to increase the number of viral load machines across India. At present, there are only ten viral load machines at NACO supported ART centers across India. “We should have mandatory viral load test for first line ART patients in the next three months. We had submitted the proposal to Global Fund last year, which was approved,” he said.