Diagnosis and management of antiretroviral-therapy failure in resource-limited settings in sub-Saharan Africa: challenges and perspectives
Harries, A.D.; Zachariah, R.; van Oosterhout, J.J.; Reid, S.D.; Hosseinipour, M.C.; Arendt, V.; Chirwa, Z.; Jahn, A.; Schouten, E.J.; Kamoto, K.
LANCET. Infectious Diseases 10(1): 60-65
2010
ISSN/ISBN: 1474-4457 PMID: 20129150 DOI: 10.1016/s1473-3099(09)70321-4Document Number: 209778
Despite the enormous progress made in scaling up antiretroviral therapy (ART) in sub-Saharan Africa, many challenges remain, not least of which are the identification and management of patients who have failed first-line therapy. Less than 3% of patients are receiving second-line treatment at present, whereas 15-25% of patients have detectable viral loads 12 months or more into treatment, of whom a substantial proportion might have virological failure. We discuss the reasons why virological ART failure is likely to be under-diagnosed in the routine health system, and address the current difficulties with standard recommended second-line ART regimens. The development of new diagnostic tools for ART failure, in particular a point-of-care HIV viral-load test, combined with simple and inexpensive second-line therapy, such as boosted protease-inhibitor monotherapy, could revolutionise the management of ART failure in resource-limited settings.