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.