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- Title
Pretreatment HIV Drug Resistance Increases Regimen Switches in Sub-Saharan Africa.
- Authors
Boender, T. Sonia; Hoenderboom, Bernice M.; Sigaloff, Kim C. E.; Hamers, Raph L.; Wellington, Maureen; Shamu, Tinei; Siwale, Margaret; Maksimos, Eman E. F. Labib; Nankya, Immaculate; Kityo, Cissy M.; Adeyemo, Titilope A.; Akanmu, Alani Sulaimon; Mandaliya, Kishor; Botes, Mariette E.; Ondoa, Pascale; de Wit, Tobias F. Rinke
- Abstract
Background: After the scale-up of antiretroviral therapy (ART) for human immunodeficiency virus (HIV) infection in Africa, increasing numbers of patients have pretreatment drug resistance. Methods: In a large multicountry cohort of patients starting standard first-line ART in six African countries, pol genotyping was retrospectively performed if viral load (VL) ≥1000 cps/mL. Pretreatment drug resistance was defined as a decreased susceptibility to ≥1 prescribed drug. We assessed the effect of pretreatment drug resistance on allcause mortality, new AIDS events and switch to second-line ART due to presumed treatment failure, using Cox models. Results: Among 2579 participants for whom a pretreatment genotype was available, 5.5% had pretreatment drug resistance. Pretreatment drug resistance was associated with an increased risk of regimen switch (adjusted hazard ratio [aHR] 3.80; 95% confidence interval [CI], 1.49-9.68; P = .005) but was not associated with mortality (aHR 0.75, 95% CI, .24-2.35; P = .617) or new AIDS events (aHR 1.06, 95% CI, .68-1.64; P = .807). During three years of follow up, 106 (4.1%) participants switched to second-line, of whom 18 (17.0%) switched with VL < 1000 cps/ mL, 7 (6.6%) with VL ≥ 1000 cps/mL and no drug resistance mutations (DRMs), 46 (43.4%) with VL ≥ 1000 cps/ mL and ≥1 DRMs; no HIV RNA data was available for 32 (30.2%) participants. Conclusions: Given rising pretreatment HIV drug resistance levels in sub-Saharan Africa, these findings underscore the need for expanded access to second-line ART. VL monitoring can improve the accuracy of failure detection and efficiency of switching practices.
- Subjects
SUB-Saharan Africa; DRUG resistance; ANTIRETROVIRAL agents; MORTALITY of AIDS patients; VIRAL load; MEDICAL statistics
- Publication
Clinical Infectious Diseases, 2015, Vol 61, Issue 11, p1749
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/civ656