Evaluation of Viral Load as an Alternative to Western Blot for Confirming HIV Infection in a Moroccan Context

Background: In Morocco, the transition from Western Blot (WB) to viral load testing for HIV confirmation aligns with WHO recommendations. This study evaluates the diagnostic performance of PCR-based viral load as an alternative to WB in a Moroccan clinical context. Methods: A retrospective descriptive analysis was conducted using data from 232 hospitalized patients (175 men, 94 women; median age 42–44 years) at Ibn Rochd University Hospital (April 2021–March 2022). WB and initial pre-therapeutic viral load (quantitative RT-PCR) results were compared. Statistical measures included sensitivity, specificity, positive predictive value (PPV), and Youden Index (YI). Results: Viral load testing demonstrated 95% sensitivity, 100% specificity, and 100% PPV, with a YI of 95%. Notably, 52.8% of patients exhibited high or very high viral loads (>100,000 copies/mL), reflecting delayed diagnosis. WB, while specific (99.9%), has limitations in turnaround time and early-phase sensitivity. Conclusion: PCR-based viral load testing offers superior advantages, including rapid results, quantitative assessment, and enhanced sensitivity during early infection. Its high diagnostic accuracy supports its adoption as a confirmatory tool in Morocco, aligning with national goals to improve early HIV diagnosis, patient management, and epidemic control. Study limitations include retrospective design and potential hospital-based selection bias. These findings advocate for policy shifts toward molecular testing to optimize HIV care in resource-limited settings.