Diagnosis and management of antiretroviral-therapy failure in resource-limited settings in sub-Saharan Africa: challenges and perspectives.
Harries, Anthony D;
Zachariah, Rony;
van Oosterhout, Joep J;
Reid, Steven D;
Hosseinipour, Mina C;
Arendt, Vic;
Chirwa, Zengani;
Jahn, Andreas;
Schouten, Erik J;
Kamoto, Kelita;
(2010)
Diagnosis and management of antiretroviral-therapy failure in resource-limited settings in sub-Saharan Africa: challenges and perspectives.
The Lancet infectious diseases, 10 (1).
pp. 60-65.
ISSN 1473-3099
DOI: https://doi.org/10.1016/S1473-3099(09)70321-4
Permanent Identifier
Use this Digital Object Identifier when citing or linking to this resource.
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.