Human immunodeficiency virus (HIV) RNA in plasma as the preferred target for therapy in patients with HIV infection: a critique.

The measurement of human immunodeficiency virus (HIV) RNA copies in plasma establishes the prognosis for HIV-infected patients and provides a rapid method of assessing the efficacy of a new antiretroviral agent. However, whether or not periodic measurement of plasma HIV RNA will aid physicians in the long-term treatment of infected patients remains to be proven. Dr. Fessel has reviewed the available literature and suggests that the enthusiasm for this technique of managing HIV infection may be premature. Dr. Fessel emphasizes that solid evidence is needed to prove that prolonged suppression of plasma levels of HIV RNA reflects suppression of viral replication in the lymphoreticular tissue and prevents selection of resistant HIV variants. With such evidence, the usefulness of the plasma HIV RNA assay in the treatment of HIV-infected patients will be more firmly established.