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 AIDS Global Management: What Does Therapeutic FailureReally 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) incontrollingAIDS epidemic, whether by helping restore the immune response orby inhibiting the viral replication. Instead, the key point on which to insist liesnot so much in rejecting a scientifically valuable concept as in questioning ageographically restricted fact…As a crucialnotion in terms of health policy andmedical practice,what isusually labelled as “therapeutic failure” does raise some questions. Amongothers: What does it exactly mean within specific context of a world-spreadingconcern such as HIV/AIDS? Another question now being asked is: What does“therapeutic failure” imply in fact? For each pending question, the answer iscomplex but some experience-and evidence-based facts stand out.A problem with “therapeutic failure” is that it does not reflect reality on asworldwide a geographical basis as possible. For example, the concept is almostexclusively applied to very few patients (from very few countries too) in whomARVs have succeeded neither in restoring an optimalimmune response nor inreducing significantly the viral load… In fact, the notion is geographicallyrestricted, since only a handful of HIV-infected patients –far less than half thepatients 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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