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

• Published in: The Lancet infectious diseases Vol. 10; no. 1; pp. 60 - 65
• Main Authors: Harries, Anthony D, Prof, Zachariah, Rony, PhD, van Oosterhout, Joep J, PhD, Reid, Steven D, PhD, Hosseinipour, Mina C, MD, Arendt, Vic, MD, Chirwa, Zengani, MBBS, Jahn, Andreas, PhD, Schouten, Erik J, MD, Kamoto, Kelita, MBBS
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 2010; Lancet Publishing Group; Elsevier Limited
• Subjects: Africa South of the Sahara - epidemiology; Anti-HIV Agents - administration & dosage; Anti-HIV Agents - economics; Anti-HIV Agents - therapeutic use; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiretroviral agents; Antiviral agents; Biological and medical sciences; Health Care Costs; HIV Infections - economics; HIV Infections - epidemiology; HIV Infections - therapy; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infectious Disease; Infectious diseases; Medical sciences; Pharmacology. Drug treatments; RNA, Viral; Treatment Failure; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Viral Load; Sub-Saharan Africa; Africa; Africa South of the Sahara; Infection; Immunopathology; Antiretroviral agent; Chemotherapy; Treatment; Clinical management; Viral disease; Antiviral; AIDS; Diagnosis; Immune deficiency; Failure
• ISSN: 1473-3099; 1474-4457
• DOI: 10.1016/S1473-3099(09)70321-4

Summary 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.