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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Low lopinavir plasma or hair concentrations explain second-line protease inhibitor failures in a resource-limited setting
Journal of Acquired Immune Deficiency Syndromes, Volume 56, No. 4, Year 2011
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Description
Background: In resource-limited settings, many patients, with no prior protease inhibitor (PI) treatment on a second-line, high genetic barrier, ritonavir-boosted PI-containing regimen have virologic failure. Methods: We conducted a cross-sectional survey to investigate the aetiology of virologic failure in 2 public health antiretroviral clinics in South Africa documenting the prevalence of virologic failure (HIV RNA load >500 copies/mL) and genotypic antiretroviral resistance; and lopinavir hair and plasma concentrations in a nested case-control study. Results: Ninety-three patients treated with a second-line regimen including lopinavir boosted with ritonavir were included, of whom 50 (25 cases, with virologic failure and 25 controls) were included in a nested case control study. Of 93 patients, 37 (40%) had virological failure, only 2 of them had had major PI mutations. The negative predictive values: probability of failure with lopinavir plasma concentration >1 μg/mL or hair concentrations >3.63 ng/mg for virologic failure were 86% and 89%, and positive predictive values of low concentrations 73% and 79%, respectively, whereas all virologic failures with HIV RNA loads above 1000 copies per milliliter, of patients without PI resistance, could be explained by either having a low lopinavir concentration in plasma or hair. Conclusions: Most patients who fail a lopinavir/ritonavir regimen, in our setting, have poor lopinavir exposure. A threshold plasma lopinavir concentration (indicating recent lopinavir/ritonavir use) and/or hair concentration (indicating longer term lopinavir exposure) are valuable in determining the aetiology of virologic failure and identifying patients in need of adherence counselling or resistance testing. © 2011 Lippincott Williams & Wilkins.
Authors & Co-Authors
Van Zyl, Gert Uves
South Africa, Stellenbosch
Stellenbosch University
Van Mens, Thijs E.
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
McIlleron, Helen Margaret
South Africa, Cape Town
University of Cape Town
Zeier, Michèle Desiré
South Africa, Tygerberg
Tygerberg Hospital
Nachega, J. B.
South Africa, Tygerberg
Tygerberg Hospital
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
Decloedt, Eric H.
South Africa, Cape Town
University of Cape Town
Malavazzi, Carolina
South Africa, Cape Town
Médicins Sans Frontières
Smith, Peter John
South Africa, Cape Town
University of Cape Town
Huang, Yong
United States, San Francisco
University of California, San Francisco
van der Merwe, Lize
South Africa, Tygerberg
South African Medical Research Council
South Africa, Bellville
University of the Western Cape
Gandhi, Monica
United States, San Francisco
Ucsf School of Medicine
Maartens, Gary Tuberculosis
South Africa, Cape Town
University of Cape Town
Statistics
Citations: 107
Authors: 12
Affiliations: 10
Identifiers
Doi:
10.1097/QAI.0b013e31820dc0cc
ISSN:
15254135
Research Areas
Genetics And Genomics
Infectious Diseases
Study Design
Cross Sectional Study
Case-Control Study
Study Approach
Quantitative
Study Locations
South Africa