Signs of HIV treatment failure to be aware of
HIV treatment failure, a concerning development for individuals living with the virus, can occur due to various reasons. A study from 2018 found that treatment failure happened at a rate of 20.3%.
Poor adherence to antiretroviral therapy (ART) is a significant cause of treatment failure. Forgetting appointments, side effects, socioeconomic barriers, and perceived good health can lead to inconsistent medication intake, which in turn can result in drug resistance. Drug resistance develops when the virus mutates, often due to inconsistent medication intake.
Co-infections, such as tuberculosis or other illnesses, can also complicate treatment and increase the odds of failure. Substance use, including alcohol and tobacco, raises the risk of failure by impacting adherence or interacting with medications.
Signs of HIV treatment failure involve a persistent or rebound increase in HIV viral load after initial suppression (virologic failure), declining CD4 cell counts indicating immune deterioration, clinical symptoms including opportunistic infections or progression of HIV-related conditions despite therapy, and laboratory evidence of drug resistance mutations if tested.
To monitor treatment, doctors order viral load tests at regular intervals, typically 3-6 months apart. A High viral load result is a sign that the HIV treatment has stopped working, and a doctor will need to change the treatment plan. On the other hand, a Negative or undetectable viral load result indicates that the HIV medications are working so well that the level of HIV in a person's blood is too low for the test to detect.
Sometimes, there can be a small increase in the viral load, known as a blip. This happens when the viral load becomes briefly detectable and later returns to undetectable.
HIV treatment failure can also result from issues with medication absorption, drug interactions, and inadequate dosing. The virological failure (inability to maintain suppression of HIV RNA) occurrence in the same study was 14.7%.
CD4 cells are immune system cells targeted by HIV, and decreased CD4 levels can be caused by ineffective or absent HIV treatment and other factors such as circadian influence, acute infection, chemotherapy, stress, fatigue, single dose steroids, alcohol use, pregnancy, nicotine use, and flu-like symptoms. A count of below 200 CD4 cells per microliter is one of the criteria for the definition of AIDS used by the Centers for Disease Control and Prevention (CDC). The immunological failure (suppression of CD4+ cells) occurrence in the same study was 13.2%.
The World Health Organization states that up to 50% of adults can experience drug resistance to the drug class known as non-nucleoside reverse transcriptase inhibitors (NNRTIs). Early recognition through viral load monitoring and addressing adherence barriers along with resistance testing are key to managing treatment failure.
In summary, treatment failure is typically indicated by a detectable or rising viral load and/or falling CD4 counts in the face of ART, usually caused by poor adherence, drug resistance, or complicating factors like co-infections and substance use. Regular viral load testing and consistent medication intake are crucial for effective HIV management.
- Poor adherence to antiretroviral therapy can lead to inconsistent medication intake and cause treatment failure.
- Forgetting appointments, side effects, socioeconomic barriers, and perceived good health can contribute to poor adherence.
- Substance use, including alcohol and tobacco, raises the risk of HIV treatment failure by impacting adherence or interacting with medications.
- Co-infections such as tuberculosis or other illnesses can complicate HIV treatment and increase the odds of treatment failure.
- A persistent or rebound increase in HIV viral load after initial suppression is a sign of HIV treatment failure.
- Declining CD4 cell counts are indicative of immune deterioration and can signal HIV treatment failure.
- Clinical symptoms including opportunistic infections, progression of HIV-related conditions, and drug resistance mutations can also indicate treatment failure.
- To monitor HIV treatment, doctors order viral load tests at regular intervals.
- A high viral load result indicates that the HIV treatment has stopped working, requiring a change in the treatment plan.
- A Negative or undetectable viral load result suggests that the HIV medications are working effectively.
- CD4 cells, immune system cells targeted by HIV, decrease due to ineffective or absent treatment and other factors.
- A CD4 count below 200 cells per microliter is one of the criteria for the definition of AIDS according to the Centers for Disease Control and Prevention (CDC).
- Drug resistance to the drug class known as non-nucleoside reverse transcriptase inhibitors can develop in up to 50% of adults.
- Regular viral load testing, early recognition, and addressing adherence barriers are key to managing treatment failure.
- Other factors affecting CD4 levels include circadian influence, acute infection, stress, fatigue, alcohol use, pregnancy, nicotine use, and flu-like symptoms.
- Additionally, issues with medication absorption, drug interactions, and inadequate dosing can result in HIV treatment failure.
