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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Drug resistance patterns and virus re-suppression among HIV-1 subtype C infected patients receiving non-nucleoside reverse transcriptase inhibitors in South Africa
Journal of AIDS and Clinical Research, Volume 2, No. 2, Year 2011
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Description
Background: Emergence of HIV-1 drug resistance is at times an inevitable and anticipated consequence of antiretroviral therapy (ART) failure. We examined drug resistance patterns and virus re-suppression among subtype C-infected South African patients receiving first-line ART. Methods: Treatment records of 431 patients on NNRTI-containing regimens for a median of 45 months were analyzed. Patients with viral load (VL) >400 copies/mL were followed and drug resistance mutations (DRM) were re-assessed. Associations between clinical/demographic measures and drug resistance/virologic outcomes were examined using Fisher exact and ordinal and logistic regression. Results: Ten percent of patients (43/431) were viremic at enrollment (98%) sequences were obtained from 38/43. Of those, 82% had 1-7 DRM. In bivariate analysis remote exposure to single-dose nevirapine or prior ART; higher CD4 counts; lower VL; and >6 months of virologic failure were significantly associated with number of DRM. Of 25 viremic patients followed for a median of 8 months on a continued first-line regimen, 12 (48%) re-suppressed, six with K103N and three with M184V. Thirteen (52%) had continued virologic failure which was significantly associated with detectable VL >6 months prior to enrollment and number of DRM. Conclusion: Among these HIV-1 subtype C-infected patients, DRM numbers and patterns were associated with prior exposure to sub-optimal ART, adherence and duration of virologic failure. Viral re-suppression in the presence of K103N and M184V challenges assumptions about drug resistance. In resource-limited settings, where genotyping and alternative drug options are unavailable, continuing first-line treatment, reinforcing adherence and regular virologic monitoring may be effective even after virologic failure. © 2011 El-Khatib Z, et al.
Authors & Co-Authors
El Khatib, Ziad
Sweden, Stockholm
Karolinska Institutet
South Africa, Johannesburg
National Institute for Communicable Diseases
DeLong, Allison K.
United States, Providence
Brown University
Katzenstein, David A.
United States, Stanford
Stanford University School of Medicine
Ekström, Anna Mia
Sweden, Stockholm
Karolinska Institutet
Ledwaba, Johanna
South Africa, Johannesburg
National Institute for Communicable Diseases
Mohapi, Lerato
South Africa, Johannesburg
University of the Witwatersrand
Laher, Fatima
South Africa, Johannesburg
University of the Witwatersrand
Petzold, Max Gustav
Sweden, Gothenburg
Nordiska Högskolan För Folkhälsovetenskap
Morris, Lynn
South Africa, Johannesburg
National Institute for Communicable Diseases
Kantor, Rami
United States, Providence
The Warren Alpert Medical School
Statistics
Citations: 40
Authors: 10
Affiliations: 7
Identifiers
Doi:
10.4172/2155-6113.1000117
e-ISSN:
21556113
Research Areas
Infectious Diseases
Study Locations
South Africa