Diagnosis and management of antiretroviral-therapy failure in resource-limited settings in sub-Saharan Africa: challenges and perspectives.
AuthorsHarries, Anthony D
van Oosterhout, Joep J
Reid, Steven D
Hosseinipour, Mina C
Schouten, Erik J
AffiliationInternational Union against Tuberculosis and Lung Disease, Paris, France. email@example.com
MetadataShow full item record
JournalThe Lancet Infectious Diseases
AbstractDespite 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.
- Extraordinary heterogeneity of virological outcomes in patients receiving highly antiretroviral therapy and monitored with the World Health Organization public health approach in sub-saharan Africa and southeast Asia.
- Authors: Aghokeng AF, Monleau M, Eymard-Duvernay S, Dagnra A, Kania D, Ngo-Giang-Huong N, Toni TD, Touré-Kane C, Truong LX, Delaporte E, Chaix ML, Peeters M, Ayouba A, ANRS 12186 Study Group.
- Issue date: 2014 Jan
- Mortality after failure of antiretroviral therapy in sub-Saharan Africa.
- Authors: Keiser O, Tweya H, Braitstein P, Dabis F, MacPhail P, Boulle A, Nash D, Wood R, Lüthi R, Brinkhof MW, Schechter M, Egger M, ART-LINC of IeDEA Study Group.
- Issue date: 2010 Feb
- Tackling virological failure in HIV-infected children living in Africa.
- Authors: Jenabian MA, Costiniuk CT, Mboumba Bouassa RS, Chapdeleine Mekue Mouafo L, Brogan TV, Bélec L
- Issue date: 2015
- Resistance at virological failure using boosted protease inhibitors versus nonnucleoside reverse transcriptase inhibitors as first-line antiretroviral therapy--implications for sustained efficacy of ART in resource-limited settings.
- Authors: Hill A, McBride A, Sawyer AW, Clumeck N, Gupta RK
- Issue date: 2013 Jun 15
- Effect of pretreatment HIV-1 drug resistance on immunological, virological, and drug-resistance outcomes of first-line antiretroviral treatment in sub-Saharan Africa: a multicentre cohort study.
- Authors: Hamers RL, Schuurman R, Sigaloff KC, Wallis CL, Kityo C, Siwale M, Mandaliya K, Ive P, Botes ME, Wellington M, Osibogun A, Wit FW, van Vugt M, Stevens WS, de Wit TF, PharmAccess African Studies to Evaluate Resistance (PASER) Investigators.
- Issue date: 2012 Apr