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close this bookNational Guidelines for the Clinical Management of HIV/AIDS - Tanzania (NACP; 2005; 131 pages)
View the documentLIST OF ABBREVIATIONS
View the documentACKNOWLEDGEMENTS
View the documentFOREWORD
Open this folder and view contentsCHAPTER 1: INTRODUCTION
Open this folder and view contentsCHAPTER 2: ORGANIZATION OF HIV/AIDS CARE AND TREATMENT
Open this folder and view contentsCHAPTER 3: HIV/AIDS PREVENTION
Open this folder and view contentsCHAPTER 4: PROTECTIVE MEASURES AGAINST HIV TRANSMISSION
Open this folder and view contentsCHAPTER 5: LABORATORY TESTS IN HIV/AIDS
Open this folder and view contentsCHAPTER 6: HIV/AIDS AND PREGNANCY
Open this folder and view contentsCHAPTER 7: PEDIATRIC HIV/AIDS AND RELATED CONDITIONS
Open this folder and view contentsCHAPTER 8: COMMUNITY AND HOME BASED CARE FOR PEOPLE LIVING WITH HIV/AIDS (PLHA)
Open this folder and view contentsCHAPTER 9: COUNSELLING RELATED TO HIV-TESTING AND TREATMENT ADHERENCE
Open this folder and view contentsCHAPTER 10: MANAGEMENT OF COMMON SYMPTOMS AND OPPORTUNISTIC INFECTIONS IN HIV/AIDS
Open this folder and view contentsCHAPTER 11: MANAGEMENT OF MENTAL HEALTH PROBLEMS IN HIV/AIDS
close this folderCHAPTER 12: MANAGEMENT OF HIV INFECTED PATIENTS USING ANTIRETROVIRAL DRUGS
View the document12.1 Introduction
Open this folder and view contents12.2 Types of Antiretroviral drugs
Open this folder and view contents12.3 Treatment using ARV drugs in adults and adolescents
Open this folder and view contents12.4 Recommended ARV drugs in Tanzania
Open this folder and view contents12.5 Adherence to Antiretroviral Therapy
close this folder12.6 Changing of Antiretroviral Therapy
View the document12.6.1 Changing Antiretroviral therapy because of treatment failure
View the document12.6.2 Changing Antiretroviral therapy because of toxicity
View the document12.7 Second-Line ARV Regimen
Open this folder and view contents12.8 Monitoring Patients on ARV Therapy.
Open this folder and view contents12.9 Laboratory Monitoring of patients on second line drugs
Open this folder and view contents12.10 Treatment failure with second line regimen
View the document12.11 Contraindications (relative) for initiation of ART
View the document12.12 Discontinuation of ART
Open this folder and view contentsCHAPTER 13: ARV THERAPY IN INFANTS AND CHILDREN
Open this folder and view contentsCHAPTER 14: USE OF ARVS IN SPECIAL CIRCUMSTANCES
Open this folder and view contentsCHAPTER 15: HIV/AIDS AND NUTRITION
Open this folder and view contentsCHAPTER 16: MANAGEMENT OF ANTIRETROVIRAL MEDICINES
Open this folder and view contentsCHAPTER 17: CERTIFICATION OF HEALTHCARE FACILITIES AS CARE AND TREATMENT SITES
 

12.6.1 Changing Antiretroviral therapy because of treatment failure

Treatment failure can be defined as virologic, immunologic and/or clinical. Treatment failure results from failure to suppress viral replication with the development of viral resistance. Primary virologic failure is less than 10 fold drop in viral load after 6-8 weeks of therapy. Secondary virologic failure is 10 fold increase from lowest recorded level. Immunologic failure is defined as a 30% drop in CD4 count from peak value or a return to pre-ART baseline or lower. Clinical failure is progression of disease with the development of opportunistic infections or malignancy occurring 3 months or more after initiation of ART.

In Tanzania, immunological and clinical parameters will be used to identify failure. However, in light of dropping costs of performing viral load measurements, along with simplification of the processes, where available, viral load parameters should also be applied.

Clinical failure must be distinguished from Immune Reconstitution Syndrome. A favourable CD4 T-cell response can occur with incomplete viral load suppression and might not indicate an unfavourable prognosis. Continuation of existing therapy does not lead to rapid accumulation of drug-resistant virus in every patient. A reasonable strategy is maintenance of the regimen, with redoubled efforts at optimising adherence and increased monitoring. If it is determined that a patient should switch regimens due to treatment failure, there should be a switch from their first-line combination to a completely new standardized second-line regimen.

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