Questions Help Find AIDS Patients Who Are Vulnerable to Drug Resistance

Due to cost and technology limitations, HIV/AIDS patients in Africa rarely undergo testing to determine whether they are developing resistance to first-line medicines.

However, researchers from Makerere University's hospital in Kampala, Uganda, along with US and Belgian scientists, have developed a formula for predicting which patients are at risk for treatment failure. Their methods, based on close questioning of patients, appear to be more effective than current World Health Organization guidelines, which are determined by clinical signs of advancing disease and a CD4 count, an easier and less expensive technique than viral load tests.

The team questioned 496 patients concerning how often they had taken their pills in the last three days, four weeks, and since they started drug therapy; weight loss; and rashes. Patients were also asked whether they had ever missed two days' worth of medicine; if they had ever paid for treatment; and whether women had ever had single-dose nevirapine during childbirth. Blood samples were taken for CD4 counts.

Treatment failure was predicted by having ever missed two days of medicine and having ever had a 30 percent decline in CD4 count, the researchers found, recommending that viral load testing -- if available -- be done on those patients first.

The study, "Development and Evaluation of a Clinical Algorithm to Monitor Patients on Antiretrovirals in Resource-Limited Settings Using Adherence, Clinical and CD4 Cell Count Criteria," was published in the Journal of the International AIDS Society (2009; doi:10.1186/1758-2652-12-3).

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