Diagnosis and management of antiretroviral-therapy failure in resource-limited settings in sub-Saharan Africa: challenges and perspectives.
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.
International Union against Tuberculosis and Lung Disease, Paris, France. adharries@theunion.org
Anthony D
AD
Harries
Rony
R
Zachariah
Joep J
JJ
van Oosterhout
Steven D
SD
Reid
Mina C
MC
Hosseinipour
Vic
V
Arendt
Zengani
Z
Chirwa
Andreas
A
Jahn
Erik J
EJ
Schouten
Kelita
K
Kamoto
D017954:Africa South of the Sahara / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use*; D015658:HIV Infections / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D017048:Health Care Costs; D006801:Humans; D012367:RNA, Viral; D017211:Treatment Failure; D019562:Viral Load
D019380:Anti-HIV Agents; D012367:RNA, Viral