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

Harries, Anthony; Zachariah, Rony; Oosterhout, Joep J. van; Reid, Steven D.; Hosseinipour, Mina C.; Arendt, Vic; Chirwa, Zengani; Jahn, Andreas; Schouten, Erik J; Kamoto, Kelita

doi:10.1016/s1473-3099(09)70321-4

Cited by 56 publications

(55 citation statements)

References 50 publications

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“…2 The number of patients who experience treatment failure and who need second-line therapy has also increased. 3,4,5 Second-line ART is generally the last treatment option in these settings, and about three times as expensive as first-line ART. 6 …”

Section: Introductionmentioning

confidence: 99%

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Monitoring and switching of first-line antiretroviral therapy in adult treatment cohorts in sub-Saharan Africa: collaborative analysis

et al. 2015

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Background HIV-1 viral load (VL) testing is recommended to monitor antiretroviral therapy (ART) but not universally available. We examined monitoring of first-line and switching to second-line ART in sub-Saharan Africa, 2004–2013. Methods Adult HIV-1 infected patients starting combination ART in 16 countries were included. Switching was defined as a change from a non-nucleoside reverse-transcriptase inhibitor (NNRTI)-based regimen to a protease inhibitor (PI)-based regimen, with a change of ≥1 NRTI. Virological and immunological failures were defined per World Health Organization criteria. We calculated cumulative probabilities of switching and hazard ratios with 95% confidence intervals (CI) comparing routine VL monitoring, targeted VL monitoring, CD4 cell monitoring and clinical monitoring, adjusted for programme and individual characteristics. Findings Of 297,825 eligible patients, 10,352 patients (3·5%) switched during 782,412 person-years of follow-up. Compared to CD4 monitoring hazard ratios for switching were 3·15 (95% CI 2·92–3·40) for routine VL, 1·21 (1·13–1·30) for targeted VL and 0·49 (0·43–0·56) for clinical monitoring. Overall 58.0% of patients with confirmed virological and 19·3% of patients with confirmed immunological failure switched within 2 years. Among patients who switched the percentage with evidence of treatment failure based on a single CD4 or VL measurement ranged from 32·1% with clinical to 84.3% with targeted VL monitoring. Median CD4 counts at switching were 215 cells/µl under routine VL monitoring but lower with other monitoring (114–133 cells/µl). Interpretation Overall few patients switched to second-line ART and switching occurred late in the absence of routine viral load monitoring. Switching was more common and occurred earlier with targeted or routine viral load testing.

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Section: Introductionmentioning

confidence: 99%

“…9,10,11 Patients with suppressed viral replication may thus unnecessarily be switched to second-line ART whereas patients failing first-line therapy may be switched late, or not switched at all. 3,5,12 …”

Section: Introductionmentioning

confidence: 99%

Monitoring and switching of first-line antiretroviral therapy in adult treatment cohorts in sub-Saharan Africa: collaborative analysis

et al. 2015

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“…These results suggest that the patients were immune compromised before getting care from the health facilities and could develop opportunistic infections [10]. Thus, strategies and new approaches are needed for an earlier enrollment for care mainly in resources limited-settings (RLS) and it becomes a major challenge for the national ART programs [11,12]. Despite the unavailability of VL in remote areas in Senegal, HIV-1 infected patients were followed using VL testing in the main site in the capital city.…”

Section: Discussionmentioning

confidence: 99%

The Prediction of Integrase Inhibitors Efficacy in Third Line Regimen after First and Second Line Antiretroviral Therapy Failure in Senegal

Abdallah¹

2014

J Antivir Antiretrovir

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“…Biochemical parameters including serum albumin, globulin, serum glutamateoxaloacetate transaminase (SGOT), total protein, total cholesterol, high-density lipoproteins (HDL), low-density lipoprotein(LDL), lactate dehydrogenase (LDH), and creatine kinase (CK/MB) were also evaluated by some studies as useful markers to assess the disease progression and treatment response. [4,12,35] Studies conducted in the past have demonstrated the role of HIV infection by itself irrespective of HAART therapy can result in the development of metabolic disorders including altered lipid metabolism. [36] Previous reports have also suggested the association of cardiovascular disease (CAD), acute cardiovascular events, and HAART therapy.…”

Section: Current Research and Future Perspectivementioning

confidence: 99%

Human immunodeficiency virus disease management in highly active antiretroviral therapy era: A comprehensive review

Ramana¹,

Rao²

2013

Ann Trop Med Public Health

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

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

Cited by 56 publications

References 50 publications

Monitoring and switching of first-line antiretroviral therapy in adult treatment cohorts in sub-Saharan Africa: collaborative analysis

Monitoring and switching of first-line antiretroviral therapy in adult treatment cohorts in sub-Saharan Africa: collaborative analysis

The Prediction of Integrase Inhibitors Efficacy in Third Line Regimen after First and Second Line Antiretroviral Therapy Failure in Senegal

Human immunodeficiency virus disease management in highly active antiretroviral therapy era: A comprehensive review

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