ABSTRACT
The medical management of HIV disease in the developed world has changed markedly in recent years. Highly active antiretroviral therapy (HAART) is able effectively to bring the plasma HIV-1 RNA concentrations (viral load) to below detectable limits (50 copies/ml) in large percentages of treated individuals (rates reported vary from 60 to 90 per cent). The suppression of viral replication can be sustained for at least two years in HIV-1-positive people who are able to adhere to the complex HAART regimes. Sustained suppression of HIV-1 has been shown to be related to better quality of life, slower clinical disease progression, lower hospitalisation rates and longer survival. Viral load has become an important parameter used in clinical decision making and in predicting long-term clinical outcome. International medical treatment guidelines for HIV-1-positive individuals (Carpenter et al., 1998) recommend HAART for all HIV-1-positive people with a viral load greater than 5000 to 10,000 copies/ml regardless of CD4 cell count, and who are ‘committed to the complex, long-term therapy’.
