Key message 3
Use tools to generate insight in virological failure
Diagnostic tools enabling insight in the causes of treatment failure are urgently required. Qualitative drug level testing has been shown to accurately exclude the presence of drug resistance in patients with failure of second-line ART.
In case of viral rebound it is often unknown whether there is an intake issue (incomplete adherence to the therapy) or failure of the HIV medication because the virus has become less sensitive to the drugs (drug resistance).
Drug resistance testing to assess whether drug resistant HIV has been selected informs the clinician on the effectiveness of the therapy and supports clinical decision making. But these tests are costly and require extensive laboratory infrastructure as well as specialist interpretation, limiting the capacity in most low and middle income countries.
Drug exposure testing is a low cost tool, that provides valuable information on adherence and may guide intensified adherence counselling. Given limited resources, targeted use of drug resistance testing only in patients who have a positive drug exposure test increases efficiency of resistance testing.
Want to learn more?
If you are living with HIV/counselor/nurse/clinician: Improving viral load monitoring in South Africa: lessons from the ITREMA project
If you are a pharmacologist: Point-of-Care Detection of Nonadherence to Antiretroviral Treatment for HIV-1 in Resource-Limited Settings Using Drug Level Testing for Efavirenz, Lopinavir, and Dolutegravir: A Validation and Pharmacokinetic Simulation Study
If you are a scientist/advanced HIV clinician: HIV Treatment Monitoring in Resource-Limited Settings: Current Paradigms and Future Strategies
Drug level testing as a strategy to determine eligibility for drug resistance testing after failure of ART: a retrospective analysis of South African adult patients on second-line ART
The ITREMA project is funded bij ZonMw and supported by the African HIV Care & Cure (AHC²) Foundation and the Aidsfonds. ITREMA is a collaboration between investigators from the University Medical Center Utrecht (UMCU), Utrecht University, Radboud University Medical Center Nijmegen, the University of the Witwatersrand (Johannesburg, South Africa) and Ndlovu Care Group (NCG, Limpopo, South Africa).
Get in contact with us
3584 CX Utrecht, The Netherlands
University Medical Centre Utrecht, Department of Medical Microbiology