Differentiated Care Pathways for Antiretroviral Therapy Monitoring in Malawi: Expanding Viral Load Testing in Setting of Highly Prevalent Resistance

Open Forum Infect Dis. 2017 Jun 19;4(3):ofx125. doi: 10.1093/ofid/ofx125. eCollection Summer 2017.


We quantified resistance to first-line antiretroviral therapy among previously unmonitored patients in Malawi with viremia (≥1000 copies/mL). Ninety-five percent (n = 57/61) harbored nucleoside/tide reverse transcriptase inhibitor/non-nucleoside reverse transcriptase inhibitor resistance; resistance was more common comparing >2 (97%) versus ≤2 years (87%) on therapy. Immediate switch for persons retained in care may improve monitoring efficiency and maximize clinical outcomes.

Keywords: antiretroviral therapy; human immunodeficiency virus (HIV); resistance; resource-limited settings; viral load monitoring.