The Battle against Infectious Diseases in Developing Countries: The Inseparable Twins of Diagnosis and Therapy

The lack of treatment of infectious diseases in developing countries is a tragic problem and one of the most serious challenges that the world must face at the beginning of this century. Hundreds of millions of people suffer from transmissible diseases for which treatments exist but for which the patients are not receiving treatment. The case of HIV infection is symbolic: the vast majority of patients are living in countries where access to treatment is difficult, incomplete, or impossible. The problem of access to treatment has been discussed frequently. By contrast, its crucial connections with the problem of diagnosis are rarely enunciated. However, identification of the etiology of an infectious disease and monitoring of the infection during therapy are required for effective and efficient treatment. In this issue of Clinical Chemistry, Drosten et al. (1) describe a new method based on real-time reverse tran- scription-PCR for the monitoring of HIV-1 viral load. An important concern is the genetic diversity of HIV-1 world- wide and the continued evolution of the virus. Hence, quantification of HIV-1 genome RNA in plasma presents an ongoing challenge. Since 1999 (2), several real-time PCR protocols have been proposed. Real-time PCR assays that can be developed within the laboratory are attractive for monitoring HIV-1 viremia in resource-limited settings because of their robustness, speed, and simplicity and their low cost, large dynamic range, and reduced contam- ination risk compared with traditional end-point assays. In one example, Rouet et al. (3) showed that they could transfer an automated low-cost real-time reverse tran- scription-PCR protocol for routine use in West Africa.