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

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• 作者：Anthony D Harries ; Rony Zachariah ; Joep J van Oosterhout ; Steven D Reid ; Mina C Hosseinipour ; Vic Arendt ; Zengani Chirwa ; Andreas Jahn ; Erik J Schouten ; Kelita Kamoto
• 刊名：The Lancet Infectious Diseases
• 出版年：2010
• 出版时间：January 2010
• 年：2010
• 卷：10
• 期：1
• 页码：60-65
• 全文大小：103 K

文摘

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.