Importance of routine viral load monitoring: higher levels of resistance at ART failure in Uganda and Lesotho compared with Switzerland.

Details

Serval ID
serval:BIB_736FEAF554BB
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Importance of routine viral load monitoring: higher levels of resistance at ART failure in Uganda and Lesotho compared with Switzerland.
Journal
The Journal of antimicrobial chemotherapy
Author(s)
Bachmann N., von Braun A., Labhardt N.D., Kadelka C., Günthard H.F., Sekaggya-Wiltshire C., Castelnuovo B., Kambugu A., Lejone T.I., Böni J., Yerly S., Perreau M., Klimkait T., Kouyos R.D., Fehr J.
Working group(s)
Swiss HIV Cohort Study
Contributor(s)
Anagnostopoulos A., Battegay M., Bernasconi E., Böni J., Braun D.L., Bucher H.C., Calmy A., Cavassini M., Ciuffi A., Dollenmaier G., Egger M., Elzi L., Fehr J., Fellay J., Furrer H., Fux C.A., Günthard H.F., Haerry D., Hasse B., Hirsch H.H., Hoffmann M., Hösli I., Huber M., Kahlert C.R., Kaiser L., Keiser O., Klimkait T., Kouyos R.D., Kovari H., Ledergerber B., Martinetti G., Martinez de Tejada B., Marzolini C., Metzner K.J., Müller N., Nicca D., Paioni P., Pantaleo G., Perreau M., Rauch A., Rudin C., Scherrer A.U., Schmid P., Speck R., Stöckle M., Tarr P., Trkola A., Vernazza P., Wandeler G., Weber R., Yerly S.
ISSN
1460-2091 (Electronic)
ISSN-L
0305-7453
Publication state
Published
Issued date
01/02/2019
Peer-reviewed
Oui
Volume
74
Number
2
Pages
468-472
Language
english
Notes
Publication types: Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Abstract
Emerging resistance to antiretroviral drugs may jeopardize the achievements of improved access to ART. We compared the prevalence of different resistance mutations in HIV-infected adults with virological failure in a cohort with regular routine viral load (VL) monitoring (Switzerland) and cohorts with limited access to VL testing (Uganda and Lesotho).
We considered individuals who had genotypic resistance testing (GRT) upon virological failure (≥1000 copies/mL) and were on ART consisting of at least one NNRTI and two NRTIs. From Lesotho, individuals with two subsequent VLs ≥1000 copies/mL despite enhanced adherence counselling (n = 58) were included in the analysis. From Uganda, individuals with a single VL ≥1000 copies/mL (n = 120) were included in the analysis. From the Swiss HIV Cohort Study (SHCS), a population without history of monotherapy or dual therapy with the first GRT upon virological failure (n = 61) was selected.
We found that 50.8% of individuals in the SHCS, 72.5% in Uganda and 81.0% in Lesotho harboured HIV with high-level resistance to at least two drugs from their current regimen. Stanford resistance scores were higher in Uganda compared with Switzerland for all drugs used in first-line treatment except zidovudine and tenofovir (P < 0.01) and higher in Lesotho compared with Uganda for all drugs used in first-line treatment except zidovudine (P < 0.01).
Frequent VL monitoring and possibly pretreatment GRT as done in the SHCS pays off by low levels of resistance even when treatment failure occurs. The high-level resistance patterns in Lesotho compared with Uganda could reflect a selection of strains with multiple resistance during enhanced adherence counselling.
Keywords
Adolescent, Adult, Anti-HIV Agents/therapeutic use, Cohort Studies, Cross-Sectional Studies, Drug Resistance, Viral/genetics, Female, Genotype, HIV Infections/drug therapy, HIV Infections/epidemiology, HIV Infections/virology, HIV-1/drug effects, HIV-1/genetics, Humans, Lesotho, Male, Middle Aged, Prevalence, Switzerland, Treatment Failure, Uganda, Viral Load/drug effects, Young Adult
Pubmed
Web of science
Create date
11/12/2018 11:14
Last modification date
26/06/2020 6:21
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