Managing HIV Treatment Failure: Time to REVAMP?
Authors: Roy M. Gulick, Marshall J. Glesby
Journal: Annals of Internal Medicine (2021)

EditorialsDecember 2021Managing HIV Treatment Failure: Time to REVAMP?Roy M. Gulick, MD, MPH and Marshall J. Glesby, MD, PhDRoy M. Gulick, MD, MPHDivision of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, New YorkSearch for more papers by this author and Marshall J. Glesby, MD, PhDDivision of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, New YorkSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M21-3903 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Current antiretroviral regimens suppress viral load levels, increase CD4 cell counts, and reduce HIV-related morbidity and mortality as well as HIV transmission. More than 27 million people with HIV are currently receiving antiretroviral therapy worldwide, and 90% of them are virally suppressed (1). Despite the efficacy of first-line antiretroviral regimens, virologic failure occurs and must be assessed and managed appropriately.Virologic failure on a first-line antiretroviral regimen is assessed by confirming the viral load elevation, assessing adherence and tolerability, and, in resource-rich countries, conducting genotypic drug resistance testing on the basis of short-term virologic benefits demonstrated in studies from more ...References1. UNAIDS. 2021 UNAIDS global AIDS update — confronting inequalities — lessons for pandemic responses from 40 years of AIDS. 14 July 2021. Accessed at www.unaids.org/en/resources/documents/2021/2021-global-aids-update on 27 September 2021. Google Scholar2. Durant J, Clevenbergh P, Halfon P, et al. Drug-resistance genotyping in HIV-1 therapy: the VIRADAPT randomised controlled trial. Lancet. 1999;353:2195-9. [PMID: 10392984] CrossrefMedlineGoogle Scholar3. Baxter JD, Mayers DL, Wentworth DN, et al; CPCRA 046 Study Team for the Terry Beirn Community Programs for Clinical Research on AIDS. A randomized study of antiretroviral management based on plasma genotypic antiretroviral resistance testing in patients failing therapy. AIDS. 2000;14:F83-93. [PMID: 10894268] CrossrefMedlineGoogle Scholar4. Inzaule SC, Ondoa P, Peter T, et al. Affordable HIV drug-resistance testing for monitoring of antiretroviral therapy in sub-Saharan Africa. Lancet Infect Dis. 2016;16:e267-e275. [PMID: 27569762] doi:10.1016/S1473-3099(16)30118-9 CrossrefMedlineGoogle Scholar5. Siedner MJ, Moosa MYS, McCluskey S, et al. Resistance testing for management of HIV virologic failure in sub-Saharan Africa. An unblinded randomized controlled trial. Ann Intern Med. 2021;174:1683-92. doi:10.7326/M21-2229 Google Scholar6. World Health Organization. Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach. 16 July 2021. Accessed at www.who.int/publications/i/item/9789240031593 on 27 September 2021. Google Scholar7. The Lancet HIV. End resistance to dolutegravir roll-out [Editorial]. Lancet HIV. 2020;7:e593. [PMID: 32890495] doi:10.1016/S2352-3018(20)30231-9 CrossrefMedlineGoogle Scholar8. Bezabhe WM, Chalmers L, Bereznicki LR, et al. Adherence to antiretroviral therapy and virologic failure: a meta-analysis. Medicine (Baltimore). 2016;95:e3361. [PMID: 27082595] doi:10.1097/MD.0000000000003361 CrossrefMedlineGoogle Scholar9. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV. Department of Health and Human Services. Updated 16 August 2021. Accessed at https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/AdultandAdolescentGL.pdf on 27 September 2021. Google Scholar10. Paton NI, Musaazi J, Kityo C, et al; NADIA Trial Team. Dolutegravir or darunavir in combination with zidovudine or tenofovir to treat HIV. N Engl J Med. 2021;385:330-341. [PMID: 34289276] doi:10.1056/NEJMoa2101609 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, New YorkDisclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M21-3903.Corresponding Author: Roy M. Gulick, MD, MPH, Division of Infectious Diseases, Weill Cornell Medicine, 1300 York Avenue, Box 125, New York, NY 10065; e-mail, [email protected]cornell.edu.This article was published at Annals.org on 26 October 2021. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoResistance Testing for Management of HIV Virologic Failure in Sub-Saharan Africa Mark J. Siedner , Mahomed-Yunus S. Moosa , Suzanne McCluskey , Rebecca F. Gilbert , Selvan Pillay , Isaac Aturinda , Kevin Ard , Winnie Muyindike , Nicholas Musinguzi , Godfrey Masette , Melendhran Pillay , Pravikrishnen Moodley , Jaysingh Brijkumar , Tamlyn Rautenberg , Gavin George , Rajesh T. Gandhi , Brent A. Johnson , Henry Sunpath , Mwebesa B. Bwana , and Vincent C. Marconi Metrics December 2021Volume 174, Issue 12Page: 1753-1754KeywordsAntiretroviral therapyAntiretroviralsDrug adherenceDrugsHIVMorbidityMortalityProtease inhibitorsProteasesViral load ePublished: 26 October 2021 Issue Published: December 2021 Copyright & PermissionsCopyright © 2021 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...