Abandonment of antiretroviral therapy for local AIDS remedies: a potential barrier to scale-up in sub-Saharan Africa

Abstract

Like many African countries, the scale-up of antiretroviral therapy (ART) in Zambia has progressed at an unprecedented rate. In this report, we describe the clinical course of one patient, who presented with immunologic and virologic evidence of treatment failure after nearly three years on ART. When presented with these laboratory results, this patient admitted to surreptitiously stopping ART four months previously in favor of a local “AIDS cure,” without ever disclosing to health care providers. During this time he continued to attend scheduled clinic and drug collection visits. This phenomenon may not be specific to Lusaka but the rationalizations given are unique to this setting: search for an AIDS cure, preferences for traditional medicines and/or alternative AIDS remedies and misconceptions surrounding ART. We report this phenomenon because of the concern that - should the practice become widespread - it may affect the long-term success of HIV treatment programs in sub-Saharan Africa.