Should viral load thresholds be lowered? Revisiting the WHO definition for virologic failure in patients on antiretroviral therapy in resource-limited settings
| Autor: | Jochen Ehmer, Daniel Puga, Bernard Cerutti, Joëlle Bader, Isaac Ringera, Thomas Klimkait, Michael A Hobbins, Thabo Ishmael Lejone, Christiane Fritz, Niklaus Daniel Labhardt |
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| Rok vydání: | 2016 |
| Předmět: |
0301 basic medicine
Pediatrics medicine.medical_specialty business.industry Cross-sectional study 030106 microbiology General Medicine Drug resistance Virus 03 medical and health sciences Institutional repository Regimen 0302 clinical medicine Medicine In patient 030212 general & internal medicine business Prospective cohort study Viral load |
| DOI: | 10.5451/unibas-ep43745 |
| Popis: | The World Health Organization (WHO) guidelines on antiretroviral therapy (ART) define treatment failure as 2 consecutive viral loads (VLs) ≥1000 copies/mL. There is, however, little evidence supporting 1000 copies as an optimal threshold to define treatment failure. Objective of this study was to assess the correlation of the WHO definition with the presence of drug-resistance mutations in patients who present with 2 consecutive unsuppressed VL in a resource-limited setting.In 10 nurse-led clinics in rural Lesotho children and adults on first-line ART for ≥6 months received a first routine VL. Those with plasma VL ≥80 copies/mL were enrolled in a prospective study, receiving enhanced adherence counseling (EAC) and a follow-up VL after 3 months. After a second unsuppressed VL genotypic resistance testing was performed. Viruses with major mutations against ≥2 drugs of the current regimen were classified as "resistant".A total of 1563 adults and 191 children received a first routine VL. Of the 138 adults and 53 children with unsuppressed VL (≥80 copies/mL), 165 (116 adults; 49 children) had a follow-up VL after EAC; 108 (74 adults; 34 children) remained unsuppressed and resistance testing was successful. Ninety of them fulfilled the WHO definition of treatment failure (both VL ≥1000 copies/mL); for another 18 both VL were unsuppressed but with |
| Databáze: | OpenAIRE |
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