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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Virological failure and drug resistance in patients on antiretroviral therapy after treatment interruption in lilongwe, Malawi
Clinical Infectious Diseases, Volume 55, No. 3, Year 2012
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Description
Background. Since 2004, Malawi has rapidly scaled up access to antiretroviral therapy (ART) in the national program following a public health approach with limited laboratory monitoring. We examined virological outcomes in patients with treatment interruption at 2 clinics of the Lighthouse Trust, Lilongwe, Malawi. Methods. We evaluated patients who resumed first-line ART after having at least 1 treatment interruption documented in the electronic data system in 2008-2009. Viral load (VL) was analyzed at least 2 months after resumption of ART. For VL ≥1000 copies/mL, drug-resistance genotype was characterized using the Stanford database.Results.Between June and November 2009, we enrolled 133 patients (58.7 female) with a mean age of 38.4 years. Mean duration of ART prior to treatment interruption was 14.3 months. After a minimum of 2 months following ART resumption, VL was undetectable in 81 (60.9) patients, was 400-1000 copies/mL in 12 (9.0) patients, and was ≥1000 copies/mL in 40 (30.1) patients. Genotyping and drug-resistance testing were successfully performed for 36 of 40 patients, all carrying human immunodeficiency virus type 1 subtype C. Relevant mutations affecting nonnucleoside reverse transcriptase inhibitors were found in 32 of 133 (24.1) patients and combined with relevant nucleoside reverse transcriptase mutations in 27 of 133 (20.3) patients. Conclusions. Virological failure combined with drug resistance after resumption of first-line ART occurred in 24.1 of the patients with treatment interruption, requiring a switch to protease inhibitor-based second-line therapy. Patients with treatment interruption should receive VL assessment after resumption of ART to detect treatment failure and to reduce development and spread of drug resistance. © 2012 The Author.
Authors & Co-Authors
Luebbert, Julia
Germany, Heidelberg
Institute of Public Health
Germany, Heidelberg
Universität Heidelberg
Tweya, Hannock M.
Malawi, Lilongwe
Lighthouse Trust
France, Paris
International Union Against Tuberculosis and Lung Disease
Phiri, Sam John Peter
Malawi, Lilongwe
Lighthouse Trust
Chaweza, Thom
Malawi, Lilongwe
Lighthouse Trust
Mwafilaso, J. B.
Malawi, Lilongwe
Lighthouse Trust
Hosseinipour, Mina C.
Malawi, Lilongwe
Unc Project-malawi
Ramroth, Heribert
Germany, Heidelberg
Institute of Public Health
Schnitzler, Paul
Germany, Heidelberg
Universität Heidelberg
Neuhann, H. Florian
Germany, Heidelberg
Institute of Public Health
Statistics
Citations: 50
Authors: 9
Affiliations: 5
Identifiers
Doi:
10.1093/cid/cis438
ISSN:
10584838
e-ISSN:
15376591
Research Areas
Genetics And Genomics
Health System And Policy
Study Locations
Malawi
Participants Gender
Female