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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
HIV-1 drug resistance mutations are present in six percent of persons initiating antiretroviral therapy in Lusaka, Zambia
Journal of Acquired Immune Deficiency Syndromes, Volume 55, No. 1, Year 2010
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Description
Objective: To assess the mutational patterns and factors associated with baseline drug-resistant HIV-1 present at initiation of first-line antiretroviral therapy (ART) at 3 sites in Lusaka, Zambia, in 2007-2008. Methods: Population sequencing of the HIV-1 pol gene was performed in the PharmAccess African Studies to Evaluate Resistance Monitoring cohort. Drug resistance-associated mutations (DRMs) were identified using the WHO 2009 Surveillance DRM list. Multiple logistic regression was used to assess factors associated with baseline resistance. Results: The overall prevalence of baseline resistance was 5.7% [31 of 548 participants; 95% confidence interval (CI): 3.9 to 7.9]; the prevalence of DRMs associated with nucleoside reverse transcriptase inhibitors (NRTIs), nonnucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors was 1.1%, 4.0%, and 1.1%, respectively. Resistance prevalence was 5.2% (27 of 523) in antiretroviralnaive and 16.0% (4 of 25) in antiretroviral-experienced (ie, previous use of ART or antiretroviral prophylaxis for prevention of motherto-child transmission) participants (P = 0.022). Dual-class resistance to NRTIs and NNRTIs was observed in 0.6% of participants. HIV-1 subtype C was identified in 98.0% (537 of 548) of participants. Prior antiretroviral experience (odds ratio: 4.32, CI: 1.34 to 14.0, P = 0.015) and hemoglobin level (highest tertile versus lowest tertile odds ratio: 2.74, CI: 1.09 to 6.89, P = 0.033) were independently associated with baseline resistance. Conclusions: Baseline resistance may compromise the response to standard NNRTI-based first-line ART in 6% of patients in Lusaka, Zambia. Continuous resistance monitoring is warranted to maintain individual and population-level ART effectiveness. Copyright © 2010 by Lippincott Williams & Wilkins.
Authors & Co-Authors
Hamers, Raph L.
Netherlands, Amsterdam
Pharmaccess Foundation
Netherlands, Amsterdam
Universiteit Van Amsterdam
Siwale, Margaret
Zambia, Lusaka
Lusaka Trust Hospital
Wallis, Carole Lorraine
South Africa, Johannesburg
University of the Witwatersrand
Labib, Moheb
Zambia, Lusaka
Coptic Hospital
Van Hasselt, Robbert
Netherlands, Amsterdam
Pharmaccess Foundation
Zambia, Lusaka
Kara Clinic and Laboratory
Stevens, Wendy Susan
South Africa, Johannesburg
University of the Witwatersrand
Schuurman, Rob J.
Netherlands, Utrecht
University Medical Center Utrecht
Wensing, Annemarie Marie J.
Netherlands, Utrecht
University Medical Center Utrecht
van Vugt, Michèle V.
Netherlands, Amsterdam
Pharmaccess Foundation
Netherlands, Amsterdam
Universiteit Van Amsterdam
Rinke de Wit, Tobias Floris
Netherlands, Amsterdam
Pharmaccess Foundation
Netherlands, Amsterdam
Universiteit Van Amsterdam
Statistics
Citations: 46
Authors: 10
Affiliations: 7
Identifiers
Doi:
10.1097/QAI.0b013e3181e544e0
ISSN:
15254135
Research Areas
Genetics And Genomics
Infectious Diseases
Maternal And Child Health
Study Design
Cross Sectional Study
Cohort Study
Case-Control Study
Study Locations
Zambia