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Diagnosis and management of antiretroviral-therapy failure in resource-limited settings in sub-Saharan Africa: challenges and perspectives | Journal Article / Commentary | MSF Science Portal
Journal Article
|Commentary

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

Harries AD, Zachariah R, van Oosterhout JJ, Reid SE, Hosseinipour MC, Arendt V, Chirwa Z, Jahn A, Schouten EJ, Kamoto K
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Abstract
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.

Countries

Kenya Malawi South Africa Uganda Zimbabwe

Subject Area

diagnosticsHIV/AIDS

Languages

English
DOI
10.1016/S1473-3099(09)70321-4
Published Date
01 Jan 2010
PubMed ID
20129150
Journal
Lancet Infectious Diseases
Volume | Issue | Pages
Volume 10, Issue 1
Issue Date
2010-01-01
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