SEPTEMBER 13, 1996 GAY PEOPLE'S CHRONICLE 9

COMMUNITY GROUPS

Cost may put new viral load tests out of reach

Greetings from the front. In the next several articles we will try to clear up some of the confusion that followed this year's International AIDS Conference. Let us begin by saying the AIDS crisis is not over! Far from it. We are in a much better position fighting HIV disease than we were last year. We have far more tools at our disposal-but if these tools are not used correctly or are inaccessible due to cost, the numbers of AIDS-related deaths will not abate.

There was a time

ing their past history and early indicators, there is still much to be seen. Current pricing for these tests runs from around $150 to $300.

Why is this test so important? It is believed that for many persons living with HIV (not all!) current and new drug therapies down the road may allow us to bring viral loads down to under 200 copies of virus per unit of blood). What will this mean? This may mean that for many people, for an undetermined amount of time, we will be able to avoid

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in the not too distant past that we would always ask someone who was living with HIV "What is your latest T-cell count?" While T-cell counts still appear to be important as an indicator for when to initiate prophylactic drug therapy against AIDSrelated opportunistic infections, it appears that the new viral load tests are a far better indicator for beginning anti-HIV drugs.

The Food and Drug Administration approved Roche Molecular Systems' Amplicor HIV-1 Monitor Test last June 3. This viral load test measures the quantity of free virus in plasma (the fluid portion of blood). It is becoming apparent that this test is a far better indicator of disease status.

The International AIDS Society (IAS) and the FDA are recommending that initially every HIV positive person should receive two viral load tests taken several weeks apart to establish a baseline viral load. Drug therapies indicated (see chart) would be started and further viral load tests should be done every three to four months following.

It is our hope that with the recommendations of the IAS and the FDA, that insurance companies will pay for these tests. Consider-

Parameter

Plasma RNA level for initiation of treatment

Target level of HIV RNA after treatment

developing drug resis-

tance. The belief is that when the virus is replicating at this low level, drug resistant mutations are less likely to occur. It is not yet clear for how long, or for that matter, for how many people we will be able to avoid drug resistance, but the possibility is bright for many people.

On June 17 Roche began offering two free HIV RNA baseline tests to all HIV positive patients in the United States. This program lasted only 60 days. Our best sources say that several hundred of the tests were performed on HIV positive people in the Cleveland area. This means that thousands of persons who are living with HIV in the Cleveland area did not receive these free vital tests. Having lost this window of opportunity, we are calling for community action. Understand that many of the working poor, who are uninsured, will never be able to afford these necessary tests. Poverty is the most under-reported complication of living with HIV disease.

Take five minutes today to write or call the governor or your state representative to demand that money be made available for these tests. To date there are no state moneys available for this potential lifesaving tool in the fight against AIDS.

Recommendation

More than 5,000-10,000 copies/mm3 and a CD4+ count or clinical status suggestive of progression; 30,000 to 50,000 copies regardless of laboratory or clinical status

Reduce to undetectable; or at least reduce to less than 5,000 copies as an acceptable target

Minimal decrease In HIV RNA Indicative Greater than 5 log decrease (a three-fold reduction)

of antiviral activity

Change in HIV RNA that suggests *r* treatment failure

Suggested frequency of HIV RNA measurement

Source: Project Inform, San Francisco

Return to (or within 3 to 5 log of) pretreatment of baseline value

✓

To establish baseline: 2 measurements, 2-4 weeks apart Every 3 to 4 months in conjunction with CD4+ tests Shorter intervals may be appropriate as critical decision points are neared

3-4 weeks after initiating or changing therapy

:

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