Abstract
The viral load (VL) test is not widely available in Thailand for HIV follow-up, which
relies mostly on CD4 count and clinical manifestations. Kuchinarai Crown Prince Hospital
(KCPH) has implemented the VL test in collaboration with MSF-Belgium. Coherent
PHA (N=128) for 2-7 years, including VL, CD4 count, clinical symptoms and Karnofsky
score 90-100, were used. The first arm reading involved 88 cases (68.75%) with undetectable
VL (<50 copies/ml), 84 (95.45%) having good CD4 count with no OI symptoms; that
of arm 2 involved 33 cases (25.78%) with VL between 50 and 1,000 copies/ml, with 30
cases (90.91%) having good CD4; that of the last arm involved 7 cases (5.47%) with VL >
1,000 copies/ml, of which 4 cases (57.14%) has good CD4.
Arm 2 received adherence counseling, followed by second and third VL follow-up
(3-month interval) resulting in undetectable VL after the second interval.
Arm 3 (last arm) showed no improvement in 4 cases (57.14%). They were put on
second line ART. At the end of the study, 124 cases (96.88%) out of 128 cases were undetectable
(VL < 50 copies/ml); while 4 cases (3.13%) with VL > 1000 copies/ml became
resistant to the first line ART and were switched to the second line ART.
The study shows that the systematic VL test should be included in HIV treatment to
detect treatment failure (i.e. virologic failure). The VL test is a tool for PHA active involvement
addressing adherence.
Viral load test should comprise a minimum package for HIV treatment in Thailand.
Our study shows that proper follow-up with systematic (client center) VL test reduces
the cost of second line treatment.
