Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2009 Nov;4(6):459-66.
doi: 10.1097/COH.0b013e328331dea5.

Defining treatment failure in resource-rich settings

Jeannette L Aldous  1 , Richard H Haubrich
Affiliations
Review

Defining treatment failure in resource-rich settings

Jeannette L Aldous et al. Curr Opin HIV AIDS. 2009 Nov.

Abstract

Purpose of review: To define treatment failure in resource-rich settings; summarizing current guidelines, assays, the significance of detectable viremia, and definitions of treatment failure in clinical and research settings.

Recent findings: The goal of treatment should be full viral suppression, even in highly treatment-experienced patients.

Summary: Treatment failure is defined as repeated HIV RNA values above the lower limit of detection of a sensitive assay (usually 50 copies/ml). This criterion is based on evidence that the maximum clinical benefit of antiretroviral therapy is derived by keeping the viral load as low as possible. Full viral suppression should be achievable in all patients, both treatment-naïve and experienced. Transient, low-detectable viremia ('blips') may not predict virologic breakthrough. However, consecutive or higher-level transient viremia is associated with risk of treatment failure. Defining failure by a confirmed HIV RNA more than 50 copies/ml is the most conservative approach, but the use of such low limits of detection in clinical trials may lead to a high false-positive 'failure' rate, thus a definition of 200 copies/ml may be preferable. Variation in clinical trial endpoint definitions creates a challenge for comparing results between studies. For example, using a composite endpoint to define treatment failure may result in a high proportion of 'failures' that are not related to poor virologic response.

PubMed Disclaimer

Figures

FIGURE 1
FIGURE 1
Probability of maintaining plasma viral load (pVL) below 5000 copies/ml according to pVL nadir. Raboud et al. AIDS 1998 [36]
See this image and copyright information in PMC

References

    1. Petersen ML, van der Laan MJ, Napravnik S, et al. Long-term consequences of the delay between virologic failure of highly active antiretroviral therapy and regimen modification. AIDS. 2008 Oct 18;22(16):2097–2106. - PMC - PubMed
    1. Hatano H, Hunt P, Weidler J, et al. Rate of viral evolution and risk of losing future drug options in heavily pretreated, HIV-infected patients who continue to receive a stable, partially suppressive treatment regimen. Clin Infect Dis. 2006 Nov 15;43(10):1329–1336. - PubMed
    1. Zaccarelli M, Tozzi V, Lorenzini P, et al. Multiple drug class-wide resistance associated with poorer survival after treatment failure in a cohort of HIV-infected patients. AIDS. 2005 Jul 1;19(10):1081–1089. - PubMed
    1. Easterbrook PJ, Ives N, Waters A, et al. The natural history and clinical significance of intermittent viraemia in patients with initial viral suppression to < 400 copies/ml. AIDS. 2002 Jul 26;16(11):1521–1527. - PubMed
    1. Moore AL, Youle M, Lipman M, et al. Raised viral load in patients with viral suppression on highly active antiretroviral therapy: transient increase or treatment failure? AIDS. 2002 Mar 8;16(4):615–618. - PubMed

Publication types