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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Unnecessary antiretroviral treatment switches and accumulation of HIV resistance mutations; two arguments for viral load monitoring in Africa
Journal of Acquired Immune Deficiency Syndromes, Volume 58, No. 1, Year 2011
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Description
Objectives: This study aimed to investigate the consequences of using clinicoimmunological criteria to detect antiretroviral treatment (ART) failure and guide regimen switches in HIV-infected adults in sub-Saharan Africa. Frequencies of unnecessary switches, patterns of HIV drug resistance, and risk factors for the accumulation of nucleoside reverse transcriptase inhibitor (NRTI)-associated mutations were evaluated. Methods: Cross-sectional analysis of adults switching ART regimens at 13 clinical sites in 6 African countries was performed. Two types of failure identification were compared: diagnosis of clinicoimmunological failure without viral load testing (CIF only) or CIF with local targeted viral load testing (targeted VL). After study enrollment, reference HIV RNA and genotype were determined retrospectively. Logistic regression assessed factors associated with multiple thymidine analogue mutations (TAMs) and NRTI crossresistance (≥2 TAMs or Q151M or K65R/K70E). Results: Of 250 patients with CIF switching to second-line ART, targeted VL was performed in 186. Unnecessary switch at reference HIV RNA <1000 copies per milliliter occurred in 46.9% of CIF only patients versus 12.4% of patients with targeted VL (P < 0.001). NRTI cross-resistance was observed in 48.0% of 183 specimens available for genotypic analysis, comprising ≥2 TAMs (37.7%), K65R (7.1%), K70E (3.3%), or Q151M (3.3%). The presence of NRTI cross-resistance was associated with the duration of ART exposure and zidovudine use. Conclusions: Clinicoimmunological monitoring without viral load testing resulted in frequent unnecessary regimen switches. Prolonged treatment failure was indicated by extensive NRTI cross-resistance. Access to virological monitoring should be expanded to prevent inappropriate switches, enable early failure detection and preserve second-line treatment options in Africa. Copyright © 2011 Lippincott Williams & Wilkins.
Authors & Co-Authors
Sigaloff, Kim Catherina Eve
Netherlands, Amsterdam
Universiteit Van Amsterdam
Hamers, Raph L.
Netherlands, Amsterdam
Universiteit Van Amsterdam
Wallis, Carole Lorraine
South Africa, Johannesburg
University of the Witwatersrand
Kityo, Cissy Mutuluuza
Uganda, Kampala
Joint Clinical Research Center Uganda
Siwale, Margaret
Zambia, Lusaka
Lusaka Trust Hospital
Ive, Prudence D.
South Africa, Johannesburg
University of the Witwatersrand
Botes, Mariëtte E.
South Africa, Pretoria
Muelmed Hospital
Mandaliya, Kishor N.
Kenya, Mombasa
Coast Provincial General Hospital, Kenya
Wellington, Maureen
Zimbabwe, Harare
Newlands Clinic
Osibogun, Akin A.
Nigeria, Lagos
Lagos University Teaching Hospital
Stevens, Wendy Susan
South Africa, Johannesburg
University of the Witwatersrand
van Vugt, Michèle V.
Netherlands, Amsterdam
Universiteit Van Amsterdam
Rinke de Wit, Tobias Floris
Netherlands, Amsterdam
Universiteit Van Amsterdam
Statistics
Citations: 219
Authors: 13
Affiliations: 8
Identifiers
Doi:
10.1097/QAI.0b013e318227fc34
ISSN:
15254135
Research Areas
Genetics And Genomics
Health System And Policy
Infectious Diseases
Study Design
Cross Sectional Study