Abstract
We have read with interest the study published by Shoufri et al. [1] and share the idea that the current application of the WHO viral load algorithm does not allow for effective management of patients with virological failure, whereas the emergence of HIV drug resistance, so-called the fourth HIV epidemic, is obvious [2]. We would like to provide some comments based on our experience in implementing viral load in the framework of the OPP-ERA project, which implements an open viral load platform technique in West and Central Africa (WCA). First, we regret that data from WCA have not been included, as too often in research, when this region represents a quarter of people living with HIV in sub-Saharan Africa, which makes these conclusions less generalizable at the sub-Saharan African level. In WCA, primary non-nucleoside reverse transcriptase inhibitors resistance data are currently lower than in East and Southern Africa [3]. In the framework of the OPP-ERA project, adherence strengthening targeting more than 9000 patients with viral load at least 1000 copies/ml in Guinea and Burundi made it possible to obtain a viral load less than 1000 copies/ml in 50% of cases, avoiding unjustified use of second line (personal data).