Guidelines to Antiretroviral Drug Therapy in Kenya: CHAPTER TWO: MONITORING AND CHANGING THERAPY: 2.4 Treatment failure

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Guidelines to Antiretroviral Drug Therapy in Kenya (WHO; 2001; 78 pages)
	FOREWORD
	ACKNOWLEDGMENT
	CHAPTER ONE: INITIATING ANTIRETROVIRAL THERAPY
		1.1 Introduction
		1.2 Guidelines to making a diagnosis of HIV infection
		1.3 Laboratory Diagnosis of HIV infection
		1.4 Goals of therapy
		1.5 When to start therapy
		1.6 Risks and benefits of delayed initiation of therapy and of early therapy in the Asymptomatic HIV-Infected Patient
		1.7 Antiretroviral profile
		1.8 What drug combination to start with?
	CHAPTER TWO: MONITORING AND CHANGING THERAPY
		2.1 Surrogate markers
		2.2 Resistance testing
		2.3 How often should CD4 Cell Count and Viral Load be performed (Frequency)
		2.4 Treatment failure
		2.5 Reasons for non-adherence
		2.6 Considerations for changing a failing regimen
		2.7 Guidelines for changing an antiretroviral regimen for suspected drug failure
		2.8 Potential options for changing therapy*
	CHAPTER THREE: PHARMACOTHERAPEUTICS OF ARVS
		3.1 Characteristics of available antiretroviral drugs
		3.2 Pharmacokinetic properties of Antiretrovirals
	CHAPTER FOUR: GUIDELINES FOR THE USE OF ANTIRETROVIRAL DRUGS IN PAEDIATRIC HIV INFECTION
		4.1 Overview
		4.2 Diagnosis of HIV infection in children
		4.3 When to initiate treatment
		4.4 Initiation of treatment
		4.5 Agents to choose for initial treatment
		4.6 Dosages for paediatric formulations
		4.8 Monitoring
		4.9 When to change therapy
	CHAPTER FIVE: MANAGEMENT OF HUMAN IMMUNODEFICIENCY VIRUS (HIV) INFECTED PREGNANT WOMEN AND PREVENTION OF MOTHER TO CHILD TRANSMISSION (MTCT) OF HIV
		5.1 Overview
		5.2 Factors affecting mother to child transmission
		5.3 Outline antenatal, intrapartum postpartum and postnatal care
		5.4 Antiretroviral Therapy to prevent MTCT
	CHAPTER SIX: SPECIAL CONSIDERATIONS
		6.1 Acute retroviral syndrome (ARVS)
		6.2 ARV drugs and the treatment of Tuberculosis
		6.3 Immune recovery syndrome
	CHAPTER SEVEN: WHEN TO STOP TREATMENT (INTERRUPTIONS)
		7.1 Structured treatment interruptions (STI's)
		7.2 Non structured treatment interruption
	CHAPTER EIGHT: GUIDELINES FOR POST EXPOSURE PROPHYLAXIS
		8.1 Treatment of exposure sites
		8.2 Timing of post - HIV exposure prophylaxis initiation
		8.3 Assessment of exposure risk
		8.4 Post - HIV exposure prophylaxis
		8.5 Recommended HIV serology after exposure
		8.6 Management of health care workers with accidental exposure to HIV infection
		8.7 Management of hospital staff with sharp injury or exposure to blood and body fluids
		8.8 Management of non occupational exposure to HIV infection
		8.9 Management of non-sexual and non occupational Exposures to HIV
	CHAPTER NINE: ACCESS TO DRUGS IN KENYA
	APPENDICES
		I. Drug to drug interactions
		II. Drug to drug interactions (continued)
		III. Drug Interactions Between Antiretrovirals and Other Drugs
		IV. Nucleoside Reverse Transcriptase Inhibitors (NRTIS)
		V. Drug Interactions: Protease Inhibitors
		VI. Drug Interactions: Protease Inhibitors and Non-Nucleoside Reverse Transcriptase Inhibitors - Cont.
		VII. Drug That Should Not be Used With Antiretrovirals
		VIII. Drugs that should not be used with Protease Inhibitors Antiretrovirals
		IX. HIV-related drugs with overlapping toxicities
		X. Anti-retroviral therapy for preventing MTCT
	BACK COVER

2.4 Treatment failure

Virologic Failure

Failure to reduce the viral load to an undetectable level or
Failure to reduce the viral load by at least 2 to 2.5 log 10 or
A persistent increase in viral load following a period of adequate suppression.

Immunologic Failure

Failure to restore the CD4 count to more than 200 cells/mm3 or
Failure to significantly increase CD4-cell count or
A persistent decline in CD4-cell counts after a period of immune reconstruction.

Clinical Failure

Development of new opportunistic infections, wasting, or dementia or Failure to resolve pretreatment opportunistic infections, wasting, or dementia.

ARV Failure: Causes

i) Patient Factors

• Adherence failure

ii) Clinical Factors

• Patient selection

iii) Viral Factors

• Resistance

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