Pulling Together to Combat Treatment Failure

TREAT Asia Convenes Think Tank on Preventing Treatment Failure

October 2009—Treatment failure among people living with HIV in Asia is associated with a variety of factors, including a lack of clear, up-to-date treatment information for patients, variations in drug potency or quality, and poor adherence to first-line regimens. Treatment failure is compounded in many countries by limited access to second-line therapy options and to laboratory monitoring tests that can correctly identify treatment failure.

In an effort to address these obstacles and develop ways to share the latest research on drug resistance and treatment options with affected communities, TREAT Asia convened a think tank in Bangkok in August as part of a pilot project to bring together scientists, patients, community educators, and advocates around the issue of treatment failure.

As participants shared personal and professional experiences with treatment failure, identified knowledge gaps, and proposed next steps, a growing sense emerged that current approaches to treatment literacy, and the impact of literacy on delaying treatment failure, need to be reexamined. Community treatment educators noted that there are few educational tools to help patients understand the connection between poor adherence and drug resistance. Participants also felt that people living with HIV need better access to treatment experts who could provide reliable advice about treatment changes, side effects, or laboratory results when physicians are not available.

Think tank attendees also discussed the need for more research on drug resistance in Asia and the importance of increased access to advanced laboratory testing. While the benefits of research studies and clinical trials tend to be limited to higher-income countries, such research can nonetheless provide important scientific evidence for improving patient management throughout Asia and increased access to new antiretroviral drugs and funding for lab monitoring. Participants observed that despite the increasing number of studies showing that CD4 count alone is a poor predictor of treatment failure, viral load monitoring continues to be difficult to access and is seldom paid for by national HIV programs.

"By not monitoring patients with viral load, we are giving substandard care," said Dr. Jintanat Ananworanich of HIV-NAT and the Thai Red Cross AIDS Research Centre. "Viral load is important in improving adherence, detecting treatment failure, and improving the chance that patients will respond to subsequent regimens."

One of the most frustrating obstacles for advocates working to promote understanding of treatment failure and prevent drug resistance is the limited treatment options available to patients. There has been a growing global outcry over the lack of access to affordable second-line regimens—a problem that must be addressed as more patients experience resistance to first-line drugs.

"Treatment failure and the lack of an adequate response will leave many people living with HIV in a desperate situation," said Paul Cawthorne of Médecins Sans Frontières. "If this meeting strengthens the links between clinicians, scientists, academics, and affected communities, we may have better hope for the future."

Participants concluded that community advocates, clinicians, and researchers must work together to promote better monitoring and access to treatment. As the coordinating center of the only regional program monitoring HIV drug resistance in Asia, TREAT Asia is uniquely placed to bring these stakeholders together to increase understanding of treatment failure, promote expansion of antiretroviral treatment options, and advocate for the inclusion of viral load testing in treatment services.