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AIDS Research and Treatment
Volume 2011, Article ID 736938, 6 pages
Research Article

Evaluation of WHO Criteria for Viral Failure in Patients on Antiretroviral Treatment in Resource-Limited Settings

1Infectious Diseases Institute, Makerere University, Mulago Hospital Complex, P.O. Box 22418, Kampala, Uganda
2Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
3Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA

Received 11 June 2010; Revised 18 January 2011; Accepted 15 February 2011

Academic Editor: Ann Duerr

Copyright © 2011 Barbara Castelnuovo et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Our objective was to evaluate outcomes in patients with sustained viral suppression compared to those with episodes of viremia. Methods. In a prospective cohort of patients started on ART in Uganda and followed for 48 months, patients were categorized according to viral load (VL): (1) sustained-suppression: (VL ≤1,000 copies/mL) (2) VL 1,001–10,000, or (3) VL >10,000. Results. Fifty-Three (11.2%) and 84 (17.8%) patients had a first episode of intermediate and high viremia, respectively. Patients with sustained suppression had better CD4+ T cell count increases over time compared to viremic patients ( 𝑃 < . 0 0 1 ). The majority of patients with viremia achieved viral suppression when the measurement was repeated. Only 39.6% of patients with intermediate and 19.1% with high viremia eventually needed to be switched to second line ( 𝑃 = . 0 0 8 ). Conclusions. The use of at least one repeat measurement rather than a single VL measurement could avert from 60% to 80% of unnecessary switches.