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- Title
Protease Inhibitor Resistance in the First 3 Years of Second-Line Antiretroviral Therapy for HIV-1 in Sub-Saharan Africa.
- Authors
Boender, T. Sonia; Hamers, Raph L.; Ondoa, Pascale; Wellington, Maureen; Chimbetete, Cleophas; Siwale, Margaret; Labib Maksimos, Eman E. F.; Balinda, Sheila N.; Kityo, Cissy M.; Adeyemo, Titilope A.; Sulaimon Akanmu, Alani; Mandaliya, Kishor; Botes, Mariette E.; Stevens, Wendy; Rinke de Wit, Tobias F.; Sigaloff, Kim C. E.; Akanmu, Alani Sulaimon
- Abstract
<bold>Background: </bold>As antiretroviral therapy (ART) programs in sub-Saharan Africa mature, increasing numbers of persons with human immunodeficiency virus (HIV) infection will experience treatment failure, and require second- or third-line ART. Data on second-line failure and development of protease inhibitor (PI) resistance in sub-Saharan Africa are scarce.<bold>Methods: </bold>HIV-1-infected adults were included if they received >180 days of PI-based second-line ART. We assessed risk factors for having a detectable viral load (VL, ≥400 cps/mL) using Cox models. If VL was ≥1000 cps/mL, genotyping was performed.<bold>Results: </bold>Of 227 included participants, 14.6%, 15.2% and 11.1% had VLs ≥400 cps/mL at 12, 24, and 36 months, respectively. Risk factors for a detectable VL were as follows: exposure to nonstandard nonnucleoside reverse-transcriptase inhibitor (NNRTI)-based (hazard ratio, 7.10; 95% confidence interval, 3.40-14.83; P < .001) or PI-based (7.59; 3.02-19.07; P = .001) first-line regimen compared with zidovudine/lamivudine/NNRTI, PI resistance at switch (6.69; 2.49-17.98; P < .001), and suboptimal adherence (3.05; 1.71-5.42; P = .025). Among participants with VLs ≥1000 cps/mL, 22 of 32 (69%) harbored drug resistance mutation(s), and 7 of 32 (22%) harbored PI resistance.<bold>Conclusions: </bold>Although VL suppression rates were high, PI resistance was detected in 22% of participants with VLs ≥1000 cps/mL. To ensure long-term ART success, intensified support for adherence, VL and drug resistance testing, and third-line drugs will be necessary.
- Subjects
ANTIRETROVIRAL agents; HIV; PROTEASE inhibitors; VIRAL load; REVERSE transcriptase
- Publication
Journal of Infectious Diseases, 2016, Vol 214, Issue 6, p873
- ISSN
0022-1899
- Publication type
journal article
- DOI
10.1093/infdis/jiw219