HIV-2 (Viral load by real time PCR)

Bacterial/ Viral

Report in 12Hrs

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No Fasting Required

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Quantifies viral RNA.

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HIV-2 Viral Load by Real Time PCR - Comprehensive Guide

Why is it done?
- Test Purpose: Measures the amount of HIV-2 RNA (viral copies) in the bloodstream using real-time polymerase chain reaction (PCR) technology. This quantitative test determines the exact viral burden in milliliters of blood.
- Primary Indications: Initial assessment of confirmed HIV-2 positive patients to establish baseline viral load; monitoring disease progression in untreated HIV-2 patients; assessing response to antiretroviral therapy (ART); determining need to initiate or modify treatment; evaluating treatment adherence and drug resistance; assessing immunological status and CD4 count correlation.
- Timing and Circumstances: At diagnosis of HIV-2 infection; every 3-6 months in untreated patients; 2-4 weeks after initiating or changing ART to assess early response; every 3-6 months in treated patients to monitor ongoing suppression; immediately if clinical symptoms of disease progression appear; before and after treatment modifications; for reproductive health counseling and transmission risk assessment.
Normal Range
- Reference Values: Undetectable (negative): <20 to <50 copies/mL (varies by assay sensitivity); Detectable: ≥20 to ≥50 copies/mL and above. Units of measurement: copies/mL (or log10 copies/mL when reported logarithmically).
- Interpretation of Results: Undetectable (<20-50 copies/mL): Optimal response to treatment; virus suppressed below detection limit ("U=U" - Undetectable equals Untransmittable); indicates patient on effective ART. Low-level viremia (50-1,000 copies/mL): Borderline result; possible early treatment failure or poor adherence; requires investigation and repeat testing. Detectable (>1,000 copies/mL): Active viral replication; indicates treatment failure, new infection, or untreated infection; higher transmission risk.
- What Normal vs Abnormal Means: Normal (Undetectable): HIV-2 is controlled with no measurable viremia; indicates successful treatment or non-infectious state; immune system better preserved. Abnormal (Detectable): Active HIV-2 replication; progressive immune system damage; higher risk of opportunistic infections and transmission; requires clinical intervention.
Interpretation
- Result Value Interpretation: <20 copies/mL (Undetectable/Target): Excellent virological control; on effective antiretroviral therapy; minimal risk of transmission. 20-500 copies/mL (Low viremia): Suboptimal response; possible adherence issues; may require treatment adjustment; transmissibility reduced but not eliminated. 500-10,000 copies/mL (Moderate viremia): Inadequate suppression; likely treatment failure or resistance; increased transmission risk; requires intervention. >10,000 copies/mL (High viremia): Active disease progression; poor treatment response or untreated infection; high transmission risk; urgent intervention needed.
- Clinical Significance: Viral load is strongest predictor of disease progression; correlates with CD4 count decline rate; predicts risk of opportunistic infections; determines transmission likelihood; guides treatment decisions; serves as primary marker for ART efficacy; indicates emergence of drug-resistant strains when rising on treatment.
- Factors Affecting Results: Antiretroviral medication adherence (primary factor); recent immunizations or infections (transient elevation); sample handling and processing conditions; time since infection (acute phase shows higher values); natural viral fluctuation (2-3 fold variation normal); assay sensitivity and methodology; presence of drug-resistant mutations; renal and hepatic function; inflammatory conditions; concurrent opportunistic infections.
- Result Patterns and Trends: Declining trend: Positive response to new ART; normal initial response over weeks to months. Stable low values: Successful long-term suppression; excellent prognosis with adherence. Blips (transient increases <500 copies/mL): Not necessarily treatment failure; may reflect immune control or assay variation; not cause for alarm if followed by decrease. Sustained increase: Treatment failure; urgent reassessment needed; possible drug resistance. Rebound to baseline: Discontinuation of therapy; non-adherence; treatment interruption.
Associated Organs
- Primary Organ Systems Involved: Lymphoid system (primary target): CD4+ T lymphocytes, lymph nodes, spleen, thymus, gut-associated lymphoid tissue. Central nervous system: Brain tissue, cerebrospinal fluid, meninges. Immune system: Overall immunological function and CD4 count. Hematopoietic system: Blood-forming bone marrow.
- Associated Medical Conditions: Acute retroviral syndrome (acute HIV-2 infection); AIDS (CD4 <200 cells/μL with high viral load); opportunistic infections (tuberculosis, cytomegalovirus, Pneumocystis pneumonia, cryptococcosis, toxoplasmosis); AIDS-associated malignancies (lymphomas, Kaposi sarcoma); HIV-associated dementia; HIV-associated nephropathy; Immune reconstitution inflammatory syndrome (IRIS) during treatment initiation.
- Diseases Diagnosed or Monitored: HIV-2 infection (confirmed diagnosis); AIDS staging and progression; treatment response and efficacy assessment; detection of antiretroviral treatment failure; identification of drug resistance; monitoring disease control on antiretroviral therapy; assessment of vertical transmission risk in pregnancy.
- Potential Complications with Abnormal Results: Progressive immunosuppression leading to CD4 depletion; increased risk of opportunistic infections including bacterial, fungal, viral, and parasitic pathogens; development of AIDS-defining illnesses; neurological complications and HIV encephalopathy; malignancy development; organ damage (liver, kidney, heart); vertical transmission to infants in pregnant women; higher transmission to sexual partners; reduced quality of life and increased mortality without intervention.
Follow-up Tests
- Recommended Complementary Tests: CD4 count (absolute lymphocyte count and CD4 percentage): Assess immune status and disease stage; correlates with opportunistic infection risk. CD4/CD8 ratio: Predicts immune recovery and overall prognosis. HIV-2 genotype/phenotype: Determine drug resistance mutations when viral load persistently elevated or rising. HIV-2 tropism testing: Guide selection of entry inhibitors and appropriate antiretroviral regimens.
- Further Investigations for Abnormal Results: If high viral load or rising on treatment: HIV-2 resistance testing to identify mutations; assessment of medication adherence and drug interactions; evaluation for drug toxicity or intolerance; consideration of treatment optimization. If AIDS diagnosis (CD4 <200 with high viral load): Opportunistic infection screening (tuberculin test, fungal antigen testing, CMV monitoring); prophylaxis assessment for PCP, toxoplasmosis, MAC; malignancy screening (Kaposi sarcoma, lymphoma).
- Monitoring Schedule: Untreated patients: Every 3-6 months baseline; monthly during acute infection phase. After ART initiation: 2 weeks (very early response check); 4 weeks (early response); 12 weeks (target undetectable); then every 3 months for first year. Patients with sustained undetectable viral load: Every 3-6 months ongoing; some guidelines allow 6-12 months intervals after 2+ years virological control. Treatment failure scenarios: Repeat testing 1-2 weeks after identified barrier to adherence addressed; monthly if resistance suspected.
- Related Monitoring Tests: Complete blood count (CBC): Monitor for cytopenias and immune parameters. Comprehensive metabolic panel: Assess renal and hepatic function for safety monitoring. Lipid panel: Monitor for ART-associated dyslipidemia. Liver function tests: Detect hepatotoxicity and co-infections with hepatitis B/C. Syphilis and other STI screening: Common co-infections. Pregnancy testing: For reproductive planning and vertical transmission risk. Partner notification and testing: Assess transmission risk to sexual contacts.
Fasting Required?
- Fasting Status: No fasting required. This is a blood test that measures viral RNA and does not require patient to abstain from food or fluid prior to testing.
- Patient Preparation Requirements: No special preparation needed before blood draw; patient may eat and drink normally; no need to stop medications prior to test (in fact, ART should be continued without interruption). Timing consideration: Blood draw can occur at any time of day; if measuring response to ART, draw after at least 2-4 weeks on therapy for meaningful assessment. Stability: Blood should be collected in appropriate EDTA (lavender top) tubes and processed promptly for accurate results.
- Medications and Substances: Continue all antiretroviral therapy as prescribed; do not skip doses to 'reset' before testing (will not provide accurate assessment). Continue all other medications as prescribed. No restrictions on supplements or herbal products. Alcohol consumption: No restrictions; does not affect viral load measurement.
- Special Instructions: Inform healthcare provider of recent infections, vaccinations, or immunizations (within 4 weeks) that may transiently elevate viral load. Disclose any missed doses of ART or medication non-adherence for accurate interpretation. Provide accurate history of treatment duration and any recent changes to antiretroviral regimen. Inform of any concurrent illnesses or conditions affecting immune status.

How our test process works!