Page 11 - Nursing Matters June 2021 Vol 12

current issues

Over the past few decades, great
steps have been taken to bring the HIV
epidemic in South Africa to a halt. The
rollout of antiretroviral therapy (ART)
has helped to contain the spread of the
1
virus. It is now time to evaluate these
approaches.
ITREMA is a scientific project evaluating
the current clinical practice of ART
monitoring in South Africa. The project
consists of several observational
research analyses and a clinical
trial. 2,3,4,5 The observational studies
have assessed the impact of low-level
viraemia during ART, the delay in clinical
follow-up of patients after viral rebound,
and the value of drug level testing in
viral rebound. The clinical trial is still
ongoing and compares standard-of-
care viral load monitoring during ART
with an intensified monitoring strategy
in which the viral load is measured
more frequently, and additional testing
measures including drug level and drug
resistance testing are used in the case of
an elevated viral load. The ITREMA team
regularly engages with clinicians and
policymakers on the project and specific
study findings.

The ITREMA team has developed three
key messages in order to summarise and mL should be flagged and action
disseminate study findings to healthcare What is low level taken. Furthermore, this has prompted
workers such as nurses, lay counsellors, viraemia? a discussion regarding the VL threshold
and doctors. at which a patient is considered to have
Low level viraemia means virological failure, which is currently
These key messages are: that the virus is not optimally 1000 copies/mL.
1. Low-level viraemia does not equal suppressed, a low amount of
virological suppression virus is still detectable. Low level Given the importance of low-
2. Delayed response to viral rebound viraemia is defined as a viral level viraemia, how should we
puts individuals and society at risk load (VL) between 50-1000 approach it as clinicians?
3. Use tools to generate insight in copies/mL during ART.
virological failure Based on the findings of ITREMA, as
well as other studies, guidelines have
This article highlights important aspects redefined the threshold for virological
of these key messages in a Q&A session first-line ART experience an episode failure. The Southern African HIV
with nursing care professionals. of low-level viraemia during the first Clinicians’ Society now defines
two years of follow-up. We found that virological failure as a VL greater than
What has the ITREMA study these patients have an increased risk of 50 copies/mL, which is in line with most
found regarding the importance virological failure. This risk is especially guidelines in high-income countries.
of low-level viraemia in clinical increased in patients with a VL between Recently, the South African Department
practice? 400 and 1000 copies/mL - they have of Health guidelines changed the
a five-times increased risk of virological definition of successful viral suppression
Firstly, we have shown that low- failure when compared to patients from <1000 copies/mL to <50 copies/
level viraemia occurs frequently. with a suppressed VL. These findings mL. The WHO currently still maintains a
3
Approximately 25% of patients on suggest that any VL above 50 copies/ VL threshold of 1000 copies/mL .
3
HIV Nursing Matters | June 2021 | page 9