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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Low Primary and Secondary HIV Drug-Resistance after 12 Months of Antiretroviral Therapy in Human Immune-Deficiency Virus Type 1 (HIV-1)-Infected Individuals from Kigali, Rwanda
PLoS ONE, Volume 8, No. 8, Article e64345, Year 2013
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Description
Treatment outcomes of HIV patients receiving antiretroviral therapy (ART) in Rwanda are scarcely documented. HIV viral load (VL) and HIV drug-resistance (HIVDR) outcomes at month 12 were determined in a prospective cohort study of antiretroviral-naïve HIV patients initiating first-line therapy in Kigali. Treatment response was monitored clinically and by regular CD4 counts and targeted HIV viral load (VL) to confirm drug failure. VL measurements and HIVDR genotyping were performed retrospectively on baseline and month 12 samples. One hundred and fifty-eight participants who completed their month 12 follow-up visit had VL data available at month 12. Most of them (88%) were virologically suppressed (VL≤1000 copies/mL) but 18 had virological failure (11%), which is in the range of WHO-suggested targets for HIVDR prevention. If only CD4 criteria had been used to classify treatment response, 26% of the participants would have been misclassified as treatment failure. Pre-therapy HIVDR was documented in 4 of 109 participants (3.6%) with an HIVDR genotyping results at baseline. Eight of 12 participants (66.7%) with virological failure and HIVDR genotyping results at month 12 were found to harbor mutation(s), mostly NNRTI resistance mutations, whereas 4 patients had no HIVDR mutations. Almost half (44%) of the participants initiated ART at CD4 count ≤200cell/μl and severe CD4 depletion at baseline (<50 cells/μl) was associated with virological treatment failure (p = 0.008).Although the findings may not be generalizable to all HIV patients in Rwanda, our data suggest that first-line ART regimen changes are currently not warranted. However, the accumulation of acquired HIVDR mutations in some participants underscores the need to reinforce HIVDR prevention strategies, such as increasing the availability and appropriate use of VL testing to monitor ART response, ensuring high quality adherence counseling, and promoting earlier identification of HIV patients and enrollment into HIV care and treatment programs. © 2013 Rusine et al.
Authors & Co-Authors
Rusine, John B.
Netherlands, Amsterdam
Amsterdam Institute for Global Health and Development
Rwanda, Kigali
National Reference Laboratory
Rwanda, Kigali
The Infectious Diseases Network for Treatment and Research in Africa Interact Project
Asiimwe-Kateera, Brenda
Netherlands, Amsterdam
Amsterdam Institute for Global Health and Development
Rwanda, Kigali
The Infectious Diseases Network for Treatment and Research in Africa Interact Project
van de Wijgert, Janneke H.H.M.
Netherlands, Amsterdam
Amsterdam Institute for Global Health and Development
United Kingdom, Liverpool
University of Liverpool
Boer, Kimberly Rachel
Netherlands, Amsterdam
Amsterdam Institute for Global Health and Development
Netherlands, Amsterdam
Royal Tropical Institute - Kit
Rwanda, Kigali
The Infectious Diseases Network for Treatment and Research in Africa Interact Project
Mukantwali, Enatha
Rwanda, Kigali
National Reference Laboratory
Karita, Etienne
Rwanda, Kigali
Project San Francisco
Gasengayire, Agnes
Rwanda, Kigali
National Reference Laboratory
Jurriaans, Suzanne
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
De Jong, Menno Douwe
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
Ondoa, Pascale
Netherlands, Amsterdam
Amsterdam Institute for Global Health and Development
Statistics
Citations: 38
Authors: 10
Affiliations: 7
Identifiers
Doi:
10.1371/journal.pone.0064345
e-ISSN:
19326203
Research Areas
Cancer
Infectious Diseases
Study Design
Cohort Study
Study Approach
Quantitative
Study Locations
Rwanda