Diagnosis of antiretroviral therapy failure in Malawi: Poor performance of clinical and immunological WHO criteria

  • J.J.G. V
  • L. B
  • R. W
 et al. 
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Objectives: In antiretroviral therapy (ART) scale-up programmes in sub-Saharan Africa viral load monitoring is not recommended. We wanted to study the impact of only using clinical and immunological monitoring on the diagnosis of virological ART failure under routine circumstances. Methods: Clinicians in two urban ART clinics in Malawi used clinical and immunological monitoring to identify adult patients for switching to second-line ART. If patients met clinical and/or immunological failure criteria of WHO guidelines and had a viral load 200 cells/mul [OR = 5.03 (2.05, 12.34)]. Active tuberculosis and Kaposi's sarcoma were the most common conditions causing misclassification of virological ART failure. Conclusion: Misclassification of virological ART failure occurs frequently using WHO clinical and immunological criteria of ART failure for poor settings. A viral load test confirming virological ART failure is therefore advised to avoid unnecessary switching to second-line regimens. © 2009 Blackwell Publishing Ltd.

Author-supplied keywords

  • *antiretroviral therapy failure
  • *drug treatment failure
  • Human immunodeficiency virus infection/dt [Drug Th
  • Kaposi sarcoma
  • Malawi
  • adolescent
  • adult
  • aged
  • article
  • clinical criteria
  • controlled study
  • criterion variable
  • drug substitution
  • drug withdrawal
  • efavirenz/dt [Drug Therapy]
  • female
  • human
  • immunological criteria
  • lamivudine/dt [Drug Therapy]
  • major clinical study
  • male
  • nevirapine/dt [Drug Therapy]
  • stavudine/dt [Drug Therapy]
  • tuberculosis
  • virus load
  • zidovudine/dt [Drug Therapy] XT - Human immunodef

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  • Van Oosterhout J.J.G.

  • Brown L.

  • Weigel R.

  • Kumwenda J.J.

  • Mzinganjira D.

  • Saukila N.

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