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.


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

Heidelberglaan 100
3584 CX Utrecht, The Netherlands

University Medical Centre Utrecht, Department of Medical Microbiology


+31 88 75 565 26