Historically, algorithms or testing protocols have not been commonly used in the diagnosis and management of viral infections. This is, in part, because of the slow turnaround time of standard viral culture methods. Only relatively recently have rapid tests that detect viral antigens or nucleic acid come into clinical use. Molecular methods have had a significant impact on the diagnosis and management of viral infections because they are rapid, reproducible, and sensitive. In addition, the use of viral load testing has revolutionized the management of some viral infections, most notably HIV-1. This report will present approaches to using protocols for the management of viral infections. Three specific examples are discussed in detail, all of which use molecular methods: (a) early disease detection, the specific example being the use of molecular testing to guide preemptive therapy for cytomegalovirus (CMV) [1] infection in solid organ transplant recipients; (b) improving overall disease management through the use of HIV-1 genotyping to guide antiretroviral therapy; and (c) viral testing to direct therapy, via HCV genotyping to determine duration of antiviral therapy. Early Disease Detection
