Diagnosis and management of antiretroviral-therapy failure in resource-limited settings in sub-Saharan Africa: challenges and perspectives.

  • HIV Clinical and Translational Research
January 01, 2010 By:
  • Harries AD
  • Zachariah R
  • van Oosterhout JJ
  • Reid SD
  • Hosseinipour MC
  • Arendt V
  • Chirwa Z
  • Jahn A
  • Schouten EJ
  • Kamoto K.

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.

2010 Jan. Lancet Infect Dis.10(1):60-5.
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