Description

The World Health Organization (WHO) has listed criteria for identifying treatment failure in a patient who is receiving a first-line antiretroviral drug regimen.


 

Different types of treatment failure:

(1) clinical

(2) CD4 positive lymphocyte count

(3) virological

 

Criteria for clinical failure:

(1) one or more of the following:

(1a) recurrence of a WHO Stage 4 condition indicative of treatment failure

(1b) onset of a new WHO Stage 4 condition indicative of treatment failure

(1c) recurrence of a WHO Stage 3 condition indicative of treatment failure (tuberculosis, severe bacterial infection)

(1d) onset of a WHO Stage 3 condition indicative of treatment failure

(2) exclusion of immune reconstitution inflammatory syndrome (IRIS) as the cause of a change in clinical status

 

where:

• Some Stage 4 conditions may not indicate treatment failure - tuberculous pleuritis, recurrent bacterial pneumonia, tuberculous lymphadenitis).

 

CD4 positive lymphocyte count - one or more of the following:

(1) absolute count persistently < 100 per µL

(2) 50% drop in absolute count from maximum levels while on treatment

(3) drop in absolute count below baseline seen before treatment started

 

Virological failure:

(1) plasma HIV viral load > 10,000 per mL (LOG10 > 4)

 

Additional suggestion (not in original criteria):

(1) identification of a drug resistant strain

 


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