Monitoring for treatment failure in patients on first-line antiretroviral treatment in resource-constrained settings
Monitoring for treatment failure in patients on first-line antiretroviral treatment in resource-constrained settings
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DOI：
10.1097/coh.0b013e3283333762
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发表时间：
2010-01-01
影响因子：
4.1
通讯作者：
Elliott, Julian
中科院分区：
文献类型：
--
作者：
Lynen, Lutgarde;Van Griensven, Johan;Elliott, Julian
审查目的低收入和中等收入国家艾滋病毒携带者的人数将在未来几年稳步增加，这些人将无法通过一线治疗并受益于方案转换。由于获得血浆艾滋病毒RNA检测的机会有限，在许多情况下诊断治疗失败是具有挑战性的。本文综述了LMICs的最新研究，探讨了治疗失败的诊断。最新发现WHO推荐的用于识别一线治疗失败的临床免疫学标准，其敏感性和阳性预测价值较低。添加依从性标准或替代的临床和实验室标记物可以提高性能，但总体来说，结果并不理想。这种情况导致延迟和不适当的过早切换到更昂贵的二线工程师。替代监测策略的成本效益存在争议，但在转向二线治疗之前，越来越多的人对使用病毒载量测试来确认病毒学失败感兴趣。然而，在LMICs中获得病毒载量测试的机会仍然有限，而且还没有简单的照顾点分析方法。目前的研究重点包括开发更简单、更便宜的分析方法，以及基于现有技术优化监测战略。
Purpose of reviewThe number of people living with HIV in low-income and middle-income countries (LMICs), who will fail first-line treatment and benefit from regimen switching, will steadily increase in the coming years. The diagnosis of treatment failure in many settings is challenging because of limited access to plasma HIV RNA testing. This article summarizes recent studies in LMICs, investigating the diagnosis of treatment failure.Recent findingsWHO recommended clinico-immunological criteria to identify first-line treatment failure, which have a low sensitivity and positive predictive value. The addition of adherence criteria or alternative clinical and laboratory markers improves performance, but overall the results are suboptimal. This situation leads to both delayed and inappropriately premature switching to more expensive second-line agents. The cost-effectiveness of alternative monitoring strategies is debated, but there is increasing interest in the use of viral load testing to confirm virological failure before switching to second-line therapy. However, access to viral load testing in LMICs remains limited and a simple point-of-care assay is not yet available.SummaryMonitoring the efficacy of antiretroviral therapy in LMICs remains a critical challenge. Current research priorities include the development of simpler, cheaper assays and optimizing monitoring strategies based on currently available technologies.