Unnecessary Antiretroviral Treatment Switches and Accumulation of HIV Resistance Mutations; Two Arguments for Viral Load Monitoring in Africa

• DOI: 10.1097/qai.0b013e318227fc34
• Publication Date: 2011-06-21T06:41:18Z
• Authors: Kim C E Sigaloff; Raph L Hamers; Carole L Wallis; Cissy Kityo; Margaret Siwale; Prudence Ive; Mariette E Botes; Kishor Mandaliya; Maureen Wellington; Akin Osibogun; Wendy S Stevens; Michèle van Vugt; Tobias F Rinke de...
• Keywords: Antiretroviral treatment

This study aimed to investigate the consequences of using clinicoimmunological criteria detect antiretroviral treatment (ART) failure and guide regimen switches in HIV-infected adults sub-Saharan Africa. Frequencies unnecessary switches, patterns HIV drug resistance, risk factors for accumulation nucleoside reverse transcriptase inhibitor (NRTI)-associated mutations were evaluated.Cross-sectional analysis switching ART regimens at 13 clinical sites 6 African countries was performed. Two types identification compared: diagnosis without viral load testing (CIF only) or CIF with local targeted (targeted VL). After enrollment, reference RNA genotype determined retrospectively. Logistic regression assessed associated multiple thymidine analogue (TAMs) NRTI cross-resistance (≥2 TAMs Q151M K65R/K70E).Of 250 patients second-line ART, VL performed 186. Unnecessary switch <1000 copies per milliliter occurred 46.9% only versus 12.4% (P < 0.001). observed 48.0% 183 specimens available genotypic analysis, comprising ≥2 (37.7%), K65R (7.1%), K70E (3.3%), (3.3%). The presence duration exposure zidovudine use.Clinicoimmunological monitoring resulted frequent switches. Prolonged indicated by extensive cross-resistance. Access virological should be expanded prevent inappropriate enable early detection preserve options