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In areas where viral load and resistance testing are not available, switching to a second-line antiretroviral therapy (ART) regimen because of presumed development of resistance to the initial regimen is guided by immunologic (i.e., fall of CD4-cell count to baseline or by 50% from on-treatment peak, or persistent level <100 cells/mm3), clinical (i.e., recurrent or new WHO Stage 4 condition, pulmonary tuberculosis, or severe bacterial infection), or adherence (<100% from month 1 to the visit preceding the failure point, as determined by the preceding thresholds) criteria. In a study conducted among HIV-infected, ART-naive patients in rural Cameroon, researchers compared these monitoring strategies.
A total of 456 patients (71% women; median …