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HIV-1 drug resistance among Ugandan adults attending an urban out-patient clinic


von Braun, Amrei; Sekaggya-Wiltshire, Christine; Bachmann, Nadine; Ssemwanga, Deogratius; Scherrer, Alexandra U; Nanyonjo, Maria; Kapaata, Anne; Kaleebu, Pontiano; Günthard, Huldrych F; Castelnuovo, Barbara; Fehr, Jan; Kambugu, Andrew (2018). HIV-1 drug resistance among Ugandan adults attending an urban out-patient clinic. Journal of Acquired Immune Deficiency Syndromes, 78(5):566-573.

Abstract

BACKGROUND Little is known about prevalence of drug resistance among HIV-infected Ugandans, a setting with over 15 years of public-sector access to antiretroviral therapy (ART) and where virological monitoring was only recently introduced. SETTING This study was conducted in the adults' out-patient clinic of the Infectious Diseases Institute, Kampala, Uganda. METHODS HIV genotyping was performed in ART naïve patients and in treatment experienced patients on ART for ≥ six months with virological failure (≥1000 copies/mL). RESULTS A total of 152 ART naïve and 2511 ART experienced patients were included. Transmitted drug resistance was detected in 9 (5.9%) patients. After a median time on ART of 4.7 years (interquartile range (IQR): 2.5-8.7), 190 patients (7.6%) had virological failure with a median viral load of 4.4 log10 copies/mL (IQR:3.9-4.9). Additionally, 146 patients had a viral load between 51 and 999 copies/ml. Most patients with virological failure (142, 74.7%) were on first-line ART. For 163 (85.8%) ART experienced patients genotype results were available. Relevant drug resistance mutations were observed in 135 (82.8%), of which 103 (63.2%) had resistance to two drug classes, and 11 (6.7%) had resistance to all drug classes available in Uganda. CONCLUSION The prevalence of transmitted drug resistance was lower than recently reported by the WHO. With 92% of all patients virologically suppressed on ART, the prevalence of virological failure was low when a cut-off of 1000 copies/mL is applied, and is in-line with the third of the 90-90-90 UNAIDS targets. However, most failing patients had developed multi-class drug resistance.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal.

Abstract

BACKGROUND Little is known about prevalence of drug resistance among HIV-infected Ugandans, a setting with over 15 years of public-sector access to antiretroviral therapy (ART) and where virological monitoring was only recently introduced. SETTING This study was conducted in the adults' out-patient clinic of the Infectious Diseases Institute, Kampala, Uganda. METHODS HIV genotyping was performed in ART naïve patients and in treatment experienced patients on ART for ≥ six months with virological failure (≥1000 copies/mL). RESULTS A total of 152 ART naïve and 2511 ART experienced patients were included. Transmitted drug resistance was detected in 9 (5.9%) patients. After a median time on ART of 4.7 years (interquartile range (IQR): 2.5-8.7), 190 patients (7.6%) had virological failure with a median viral load of 4.4 log10 copies/mL (IQR:3.9-4.9). Additionally, 146 patients had a viral load between 51 and 999 copies/ml. Most patients with virological failure (142, 74.7%) were on first-line ART. For 163 (85.8%) ART experienced patients genotype results were available. Relevant drug resistance mutations were observed in 135 (82.8%), of which 103 (63.2%) had resistance to two drug classes, and 11 (6.7%) had resistance to all drug classes available in Uganda. CONCLUSION The prevalence of transmitted drug resistance was lower than recently reported by the WHO. With 92% of all patients virologically suppressed on ART, the prevalence of virological failure was low when a cut-off of 1000 copies/mL is applied, and is in-line with the third of the 90-90-90 UNAIDS targets. However, most failing patients had developed multi-class drug resistance.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal.

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Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Epidemiology, Biostatistics and Prevention Institute (EBPI)
04 Faculty of Medicine > University Hospital Zurich > Clinic for Infectious Diseases
Dewey Decimal Classification:610 Medicine & health
Uncontrolled Keywords:Pharmacology (medical), Infectious Diseases
Language:English
Date:27 April 2018
Deposited On:05 Jun 2018 14:04
Last Modified:27 Apr 2019 00:00
Publisher:Lippincott Williams & Wilkins
ISSN:1525-4135
OA Status:Green
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1097/QAI.0000000000001717
PubMed ID:29771783

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