This study highlights the potential for targeted virologic monitoring in resource-limited settings, emphasizing that adherence during the first 24 weeks of efavirenz-based ART is a key predictor of late virologic failure (VF). The findings suggest that patients who report missed doses early in treatment are at increased risk of late VF, even after achieving initial HIV-1 RNA suppression. Additionally, pre-ART hemoglobin levels and absence of severe laboratory abnormalities are also predictive of better virologic outcomes. These results support the idea that annual monitoring might be feasible in clinical practice for most patients, while more frequent monitoring may be necessary for those at higher risk of treatment failure. This approach could help reduce costs and enhance adherence-focused interventions in settings where routine virologic testing is limited.

This study developed a risk score algorithm to predict the need for antiretroviral therapy (ART) change in resource-limited settings, where resistance testing is often unavailable. By analyzing data from a Phase IV trial, the researchers identified key demographic and clinical factors (such as baseline viral load, viral load at the time of elevated measure, treatment duration, body mass index, and adherence) that predict the need for ART adjustment. The algorithm demonstrated good predictive performance with high specificity, offering a potential tool for ART management in settings without access to resistance testing. The model could improve patient outcomes by facilitating timely ART changes, reducing resistance transmission, and lowering healthcare costs associated with unnecessary laboratory testing.

The study aimed to evaluate the non-inferiority of a regimen consisting of ritonavir-boosted lopinavir (LPV/r) plus raltegravir compared to LPV/r combined with nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs) for virological suppression in resource-limited settings. Conducted as a randomized, open-label phase 3 trial across 15 sites in nine countries, the study included HIV-positive adults with a plasma HIV-1 RNA concentration of at least 1000 copies/mL after prior non-NRTI therapy. A total of 515 participants were assigned to either the raltegravir group or the NRTI group, with follow-up revealing a cumulative probability of virological failure of 10.3% in the raltegravir group and 12.4% in the NRTI group after 48 weeks, demonstrating that raltegravir was non-inferior to NRTIs. The study also noted that while both regimens had similar rates of adverse events, the data support the use of LPV/r plus raltegravir as a viable alternative in scenarios where NRTI use is limited by toxicity or resistance. These findings align with WHO recommendations and highlight the importance of flexible treatment options in managing HIV in resource-limited settings.

This study underscores the effectiveness and durability of NNRTI-based antiretroviral therapy (ART) in perinatally HIV-infected adolescents. Despite initiating treatment later in life, adolescents showed significant improvements in catch-up growth, immune function (CD4+ recovery), and viral suppression, with high suppression rates (>80%) maintained over 5 years. The findings also highlight the importance of early ART initiation and cotrimoxazole prophylaxis in reducing NNRTI substitutions and clinical failures, which were associated with baseline low CD4+ counts and lack of prophylaxis. These results suggest that earlier intervention and comprehensive care are crucial for improving long-term health outcomes in this vulnerable population.

This study explores the capacity of HIV care facilities to conduct Targeted Spontaneous Reporting (TSR) for adverse drug reactions (ADRs) related to antiretroviral therapy (ART). The research used data from the International epidemiologic Databases to Evaluate AIDS (IeDEA) Consortium to develop a list of key facility characteristics necessary for TSR implementation, such as outcome ascertainment, laboratory monitoring, data management, and human resources. The findings indicate that while many facilities have systems in place for patient identification and adverse event documentation, the overall infrastructure for systematic pharmacovigilance remains limited. These results provide a foundational understanding for improving pharmacovigilance and integrating TSR into routine HIV care programs across diverse regions.