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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Predictors of long-term viral failure among ugandan children and adults treated with antiretroviral therapy
Journal of Acquired Immune Deficiency Syndromes, Volume 46, No. 2, Year 2007
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Description
BACKGROUND: HIV RNA viral load testing is costly and is generally unavailable in resource-limited settings. We identified predictors of viral failure and documented genotypic mutations in a subset of patients with viral failure after 12 months on antiretroviral therapy (ART). METHODS: From April 2004 to June 2005, consecutive treatment-naive patients beginning ART at a university clinic in Uganda were enrolled. Clinical information, CD4 cell count, and HIV RNA level were collected at baseline and every 3 to 6 months. Independent predictors of viral failure were identified using multivariate logistic regression. Genotypic drug resistance for 8 patients with viral failure at 12 months was measured at baseline and at 6 and 12 months. RESULTS: Five hundred twenty-six adults and 250 children (0 to 18 years of age) were started on first-line ART regimens and followed for 12 months. Outcomes could not be assessed in 13% of patients (79 died and 21 were withdrawn). Children were almost twice as likely to have viral failure compared with adults (26% vs. 14%; P = 0.0001). In adults, the sole independent predictor of viral failure was treatment with stavudine (d4T)/lamivudine (3TC)/nevirapine (NVP) versus zidovudine (ZDV)/3TC/efavirenz (EFV) (odds ratio [OR] = 2.59, 95% confidence interval [CI]: 1.20 to 5.59). In children, independent predictors of viral failure included male gender (OR = 2.44, 95% CI: 1.20 to 4.93), baseline CD4% <5 (OR = 2.69, 95% CI: 1.28 to 5.63), and treatment with d4T/3TC/NVP versus ZDV/3TC/EFV (OR = 2.46, 95% CI: 1.23 to 4.90). All 8 patients with viral breakthrough and genotypic drug resistance results had nonnucleoside reverse transcriptase inhibitor (NNRTI)- and 3TC-associated mutations. CONCLUSIONS: These data demonstrate the effectiveness of ART in a low-resource setting. Children and patients of all ages taking the d4T/3TC/NVP regimen were more likely to have viral failure. Our data suggest that viral failure occurring 6 months or more after the start of ART regimens commonly used in Uganda is likely to be associated with NNRTI- and 3TC-resistant virus. © 2007 Lippincott Williams & Wilkins, Inc.
Authors & Co-Authors
Kamya, Moses Robert K.
Uganda, Kampala
Makerere University
Uganda, Kampala
Academic Alliance for Aids Care and Prevention in Africa
Mayanja-Kizza, Harriet
Uganda, Kampala
Makerere University
Uganda, Kampala
Academic Alliance for Aids Care and Prevention in Africa
Kambugu, Andrew Ddungu
Uganda, Kampala
Academic Alliance for Aids Care and Prevention in Africa
Bakeera-Kitaka, Sabrina
Uganda, Kampala
Mulago Hospital
Semitala, Fred Collins
Uganda, Kampala
Makerere University
Mwebaze-Songa, Patricia
Uganda, Kampala
Academic Alliance for Aids Care and Prevention in Africa
Castelnuovo, Barbara C.
Uganda, Kampala
Academic Alliance for Aids Care and Prevention in Africa
Schaefer, Petra
Uganda, Kampala
Academic Alliance for Aids Care and Prevention in Africa
Spacek, Lisa A.
United States, Baltimore
Johns Hopkins Medical Institutions
Gasasira, Anne F.
Uganda, Kampala
Makerere University
Katabira, Elly Tebasoboke
Uganda, Kampala
Makerere University
Uganda, Kampala
Academic Alliance for Aids Care and Prevention in Africa
Colebunders, Robert Leon
Uganda, Kampala
Academic Alliance for Aids Care and Prevention in Africa
Belgium, Antwerpen
Universiteit Antwerpen
Quinn, Thomas Charles
Uganda, Kampala
Academic Alliance for Aids Care and Prevention in Africa
United States, Baltimore
Johns Hopkins Medical Institutions
Ronald, Allan R.
Uganda, Kampala
Academic Alliance for Aids Care and Prevention in Africa
Thomas, David L.
Uganda, Kampala
Academic Alliance for Aids Care and Prevention in Africa
United States, Baltimore
Johns Hopkins Medical Institutions
Kekitiinwa, Adeodata R.
Uganda, Kampala
Mulago Hospital
Statistics
Citations: 236
Authors: 16
Affiliations: 5
Identifiers
Doi:
10.1097/QAI.0b013e31814278c0
ISSN:
15254135
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Design
Case-Control Study
Study Locations
Uganda
Participants Gender
Male