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Researchers at Wits University, South Africa's National Health Laboratory Service (NHLS) and University Medical Center Utrecht have developed a new way to help people whose HIV viral load increased while they were taking the highly effective standard antiretroviral treatment dolutegravir (DTG).

The Intensified Treatment Evaluation and Monitoring Approach (ITREMA-2) implementation study aims to prevent the accumulation and spread of HIV-1 drug resistance in resource-limited settings.

A total of 288 people with HIV participated in the study at Hillbrow Community Health Centre and Helen Joseph Hospital, two large public HIV clinics in Johannesburg.

Instead of guessing why dolutegravir wasn't working, researchers used a blood exposure test to check whether the medicine was in a person's blood:

"An increased viral load does not automatically mean that treatment is failing because of drug resistance," says lead researcher Professor Annemarie Wensing of Wits Ezintsha and University Medical Center Utrecht. "Measuring dolutegravir in the same sample helps identify who needs resistance testing and provides clinicians and nurses with objective information to better support medication intake."

When a patient's viral load spikes, doctors face a difficult dilemma. They must decide whether to provide counseling to help the patient take their current pills or switch them to a completely new, more expensive regimen.

Previously, doctors had to wait months, provide repeated counseling and run expensive resistance tests on everyone to find out what was wrong.

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