Optimizing Treatment Monitoring in Resource Limited Settings in the Era of Routine Viral Load Monitoring

Purpose of review: Routine viral load monitoring (VLM) for patients on antiretroviral treatment (ART) is being scaled up in resource limited settings. Recent findings: VLM potentially has several roles in improving HIV care and includes identifying patients with treatment failure and in need of second-line ART. VLM can also be used as a tool to improve adherence to ART, with 60% of the patients with detectable viral load achieving suppression following ART adherence counseling. VLM may play a role in optimizing differentiated care strategies, by identifying patients who need more close follow-up and adherence support and those who need minimal support. Finally, by ensuring that patients achieve viral suppression, VLM plays an important role in prevention of transmission to partners and infants. Summary: Early reports indicate that acting on viral load results to facilitate timely switching is still an ongoing challenge with delayed switches still being common.