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AIDS Global Management:

What Does Therapeutic Failure Really Mean?
Bridging the gap and breaking the silence…

Michel ODIKA

Photo: UNAIDS.

But what is the matter? First of all, a highly necessary and useful warning.
The purpose here, then, is not to deny the efficacy of antiretrovirals (ARVs) in
controlling AIDS epidemic, whether by helping restore the immune response or
by inhibiting the viral replication. Instead, the key point on which to insist lies
not so much in rejecting a scientifically valuable concept as in questioning a
geographically restricted fact…
As a crucial notion in terms of health policy and medical practice, what is
usually labelled as “therapeutic failure” does raise some questions. Among
others: What does it exactly mean within specific context of a world-spreading
concern such as HIV/AIDS? Another question now being asked is: What does
“therapeutic failure” imply in fact? For each pending question, the answer is
complex but some experience- and evidence-based facts stand out.
A problem with “therapeutic failure” is that it does not reflect reality on as
worldwide a geographical basis as possible. For example, the concept is almost
exclusively applied to very few patients (from very few countries too) in whom
ARVs have succeeded neither in restoring an optimal immune response nor in
reducing significantly the viral load… In fact, the notion is geographically
restricted, since only a handful of HIV-infected patients – far less than half the
patients across the world – can access to life-preserving therapies.
Based upon some striking facts, it appears clearly that the very true
“therapeutic failure” is chiefly illustrated and demonstrated by two key groups.
Firstly, most HIV-infected patients from low-income countries – the hardest-hit
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by the pandemic – who cannot get ARVs yet clinically eligible for being treated.
Secondly, millions of newborns HIV-contaminated every year during pregnancy
or delivery or via breast-feeding.
What can we say in the final analysis? In terms of managing HIV/AIDS,
what “therapeutic failure” is really about on the ground, ultimately, is mostly the
medical windowpane and continuum of a historical and moral failure…

REFERENCES
1. Halsemere Group (1975). Who needs the drug companies? Halsemere
Group and War on Want, London.

2. Havlir DV, Hammer SM (2005). Patents versus patients? Antiretroviral

therapy in India. New England Journal of Medicine, 353(8):749-51.

3. Holtgrave DR (2006). Causes of the decline in AIDS death, United States,

1995-2002: prevention, treatment or both? International Journal of STD &
AIDS, 16(12):777-781.

4. WHO (2004). Scaling up antiretroviral therapy in resource-limited

settings: treatment guidelines for a public health approach. Geneva.