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The role of virological monitoring A clinical perspective . Eric Goemaere MSF South Africa . Treatment simplification? . Simplified treatment . PHC decentralization . Task shifting . HIV/TB integration .
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MSF South Africa
Impact of routine monitoring <> Immuno-clinical monitoring on regimen change
More accurate assessment of treatment failure will reduce the delay in switching to second-line drugs. Targeted use of VL can limit unnecessary switching and routine use of VL can reduce the risk of resistance.
WHO 2010 guidelines
HIV Viral Load Monitoring in Resource-Limited Regions:
Optional or Necessary?
Alexandra Calmy,1,5 Nathan Ford,6 Bernard Hirschel,2 Steven J. Reynolds,7 Lut Lynen,4 Eric Goemaere,8 Felipe Garcia de la Vega,1Luc Perrin,3 and William Rodriguez9,10, CID 2007:44
Keiser et al, AIDS 2011
Female, CHK Kinsahsa N° 040025,
Cd4 < 50 %
Cd4 < 30 %
Phase IV Oesophageal candidiasis
VL13.000 -> moved to 2nd line
Sensitivity = 17.2% (12.3% - 23.0%)
Specificity = 94.5% (93.6% - 95.3%)
PPV = 18.5% (13.3% - 24.8%)
NPV = 94.0% (93.1% - 94.9%)
M. Pujades, L. Pinoges , Epicentre, not published
( n = 2543 )
( Mary Ann Davies, Durban Aids conference June 2011)
VL3 group : 22% less likely to experience subsequent virological failure, 27% less likely to be later switched to second line regimen
Viral load at 3 months after initiation of antiretroviral therapy is associated with
better virological and treatment outcomes than at 6 months.
B. Kerschberger1, A. M. Boulle2, K. Kranzer3, K. Hilderbrand1,2, M. Schomaker2, D.Coetzee2, E.Goemaere4, N. Ford2,5, G. Van Cutsem1,2
Steven Van Den Broucke, Sandra Simons, Katharina KranzerDhodhoMunyaradzi, Carol Metcalf, KwenzakwenkosiNcube, Helen BygravePoster : THPE725 Thursday 26th
Facility based HCT :
Enrolled in care:
RIC @ 12 M**
Undetect@ 6 M
Out of facility HCT :
Source : The public health approach to identify antiretroviral therapy
failure: high-level nucleoside reverse transcriptase inhibitor resistance among Malawians failing first-line antiretroviral, Therapy, Mina C. Hosseinipour& all, AIDS 23:1127–1134
Immuno/clinical monitoring do not replace virological monitoring
Key challenges are around technical/ geographical / financial access to virological monitoring
Unitaid/ Chai/Unicef / MSF concerted efforts will work on all 3 aspects to make virological monitoring a reality in LIC by 2015