Treatment Failure

Question 1

What do you understand by Treatment failure

Answer 1

Treatment failure is when there is sub optimal response to ART

Question 2

What is clinical failure in Adolescents and adults

Answer 2

New or recurrent clinical event indicating
severe immunodeficiency (WHO clinical
stage 4 condition) after 6 months of effective
treatment.

Question 3

What is clinical failure in children

Answer 3

New or recurrent clinical event indicating 
advanced or severe immunodeficiency 
(WHO clinical stage 3 and 4 clinical 
condition with exception of TB) after 6 
months of effective treatment

Question 4

What is immunological failure in Adolescents and adults

Answer 4

CD4+ cell count falls to the baseline (or below)
Or
Persistent CD4+ cell count below 100 cells/mm3
Or
50% decline from on-therapy CD4+ cell count
peak level
Without concomitant or
recent infection to cause a
transient decline in the CD4+
cell counts.

Question 5

What is immunological failure in children

Answer 5

Younger than 5 years
Persistent CD4+ cell count below 200
cells/mm or <10%

Older than 5 years
Persistent CD4+ cell count below 100 cells/mm

Question 6

What is virological failure in Adolescents and adults

Answer 6

Plasma viral load ≥ 1000 copies/ml 6 months 
after starting ART on consecutive VL
measurements 
An individual must be taking 
ART for at least 12 months 
before it can be determined 
that a regimen has failed

Question 7

Causes of Treatment failure

Group into categories

Answer 7

Viral factors
§ Acquired drug resistance: Patients may develop drug-resistant mutations while on
ARTif maximal adherence (≥95%) is not maintained.
§ Transmitted drug resistance: Patients may be infected with drug-resistant virus
during their initial exposure or be re-infected with drug-resistant virus while on
ART.
2. Non-viral Factors
HIVTreatment failure may result when ARVplasma drug levels do not reach therapeutic
concentration. This may be due to:
§ Host factors: poor adherence to ART, malnutrition and malabsorption of drugs
§ Choice of initial ART regimen, poor potency or improper dosing
§ Drug-drug interactions

Question 8

How do you manage Treatment failure

Answer 8

Depends on the type and cause

Question 9

What is low viraemia

Answer 9

defined variably as an intermittent or persistent VL between 200 - 999
copies/ml is associated with drug resistance mutations (DRMs) and/or treatment failure, with an
incidence of virologic failure (VF) among PLHIV with persistent LLV <500 copies/mL
estimated to be about 4-8%. Persistent higher-range LLV (e.g. ≥400 copies/ml) is associated
with clinical disease progression and/or mortality

Question 10

Causes of low viraemia

Answer 10

• Adherence problems
• Bugs (Intercurrent infections)
• In-Correct ARTdosage
• Drug Interactions
• REsistance.

Question 11

Management of low viraemia

Answer 11

Identify cause
Implement EAC
Switch TLE to TLD