South Africa Adopts Smarter HIV Drug Resistance Testing
A simple idea from researchers in Johannesburg is changing how HIV care works in South Africa's public clinics. Wits University shared the news on 25 September.
Many people with HIV take dolutegravir, a standard and highly effective medicine. Sometimes, though, the amount of virus in a person's blood, called the viral load, starts to rise. Doctors then have to work out why. Has the virus become resistant to the drug, or has the person found it hard to take their pills every day?
The ITREMA-2 study tested a quick way to answer that. Along with the viral load, the lab checks whether dolutegravir is present in the same blood sample. If the medicine is missing, missed doses are the likely cause and resistance is unlikely. If the medicine is there but the virus is still rising, a full resistance test is worth doing.
In total, 288 people with HIV took part at Hillbrow Community Health Centre and Helen Joseph Hospital, two large public clinics in Johannesburg. The study was published in The Lancet HIV on 2 September. When used at confirmed treatment failure, estimated lab monitoring costs were 23% lower than with the old approach, because fewer unnecessary resistance tests are needed.
Better still, the idea is already in use. South Africa's Department of Health has added an adapted version of the strategy to its national guidelines for public HIV care. Lead researcher Professor Annemarie Wensing said a rising viral load does not automatically mean the treatment is failing because of resistance.
The approach can help people switch to a working medicine sooner when they need to, and get better support when daily pills are hard. Anyone living with HIV who has questions about their treatment should talk to their clinic or doctor.
