scholarly journals Rates of HIV-1 virological suppression and patterns of acquired drug resistance among fisherfolk on first-line antiretroviral therapy in Uganda

2019 ◽  
Vol 74 (10) ◽  
pp. 3021-3029 ◽  
Author(s):  
Jonah Omooja ◽  
Maria Nannyonjo ◽  
Grace Sanyu ◽  
Stella E Nabirye ◽  
Faridah Nassolo ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Cost Effective ◽  
Virological Suppression ◽  
First Line ◽  
Acquired Drug Resistance ◽  
Resource Limited ◽  
Adherence Support ◽  
Virological Outcomes ◽  
Pooling Strategies ◽  
Adherence Counselling

AbstractObjectivesWe examined virological outcomes, patterns of acquired HIV drug resistance (ADR), correlates of virological failure (VF) and acquired drug resistance among fisherfolk on first-line ART.MethodsWe enrolled 1169 adults on ART for a median duration of 6, 12, 24, 36 and ≥48 months and used a pooled VL testing approach to identify VF (VL ≥1000 copies/mL). We performed genotyping among VF cases and determined correlates of VF and ADR by logistic regression.ResultsThe overall virological suppression rate was 91.7% and ADR was detected in 71/97 (73.2%) VF cases. The most prevalent mutations were M184V/I (53.6%) for NRTIs and K103N (39.2%) for NNRTIs. Thymidine analogue mutations were detected in 21.6% of VF cases while PI mutations were absent. A zidovudine-based ART regimen, duration on ART (≥24 months) and secondary/higher education level were significantly associated with VF. A nevirapine-based regimen [adjusted OR (aOR): 1.87; 95% CI: 0.03–0.54)] and VL ≥10000 copies/mL (aOR: 3.48; 95% CI: 1.37–8.85) were ADR correlates. The pooling strategies for VL testing with a negative predictive value (NPV) of ≥95.2% saved US $20320 (43.5%) in VL testing costs.ConclusionsWe observed high virological suppression rates among these highly mobile fisherfolk; however, there was widespread ADR among those with VF at the first VL testing prior to intensive adherence counselling. Timely treatment switching and adherence support is recommended for better treatment outcomes. Adoption of pooled VL testing could be cost effective, particularly in resource-limited settings.

High rate of virological failure and HIV drug resistance in semi-rural Gabon and implications for dolutegravir-based regimen efficacy

2020 ◽  
Author(s):  
Jéordy D Engone-Ondo ◽  
Augustin Mouinga-Ondémé ◽  
Sonia E Lékana-Douki ◽  
Abdoulaye Diané ◽  
Antony I Mamimandjiami ◽  
...  
Keyword(s):  
Drug Resistance ◽  
High Rate ◽  
Resistance Mutations ◽  
First Line ◽  
Rural Regions ◽  
Hiv Drug Resistance ◽  
Acquired Drug Resistance ◽  
Resource Limited ◽  
Study Population ◽  
Study Participants

Abstract Background The projected UNAIDS goal of ending AIDS by 2030 requires significant global efforts to improve current and future ART strategies. In this study, we assessed viral load (VL) suppression and acquired drug resistance, as well as future efficacy of dolutegravir-based combinations for patients living in semi-rural regions of Gabon. Methods Eligible study participants were adults receiving ART and recruited between 2018 and 2019 in Franceville, Gabon. VL testing was conducted to assess VL suppression and HIV drug resistance (HIVDR) testing was performed to identify resistance mutations and assess their impact on ongoing and future ART regimens. Results We recruited 219 participants overall. The median time on ART was 27 months and 216/219 participants were on first-line ART. VL suppression (VL < 1000 copies/mL) was 57.1% (95% CI 50.5–63.8) overall; 59.4% (51.4–67.5) and 52.2% (40.3–64.2) for women and men, respectively. The overall prevalence of HIVDR was 21.9% among the study population and 67.2% among those who failed ART. Presence of both NRTI and NNRTI mutations was found in 84.6% of sequences with drug resistance mutations, and full activity of a dolutegravir-based first-line regimen including tenofovir disoproxil fumarate/lamivudine/dolutegravir was expected only for 5/39 patients with a resistant virus. Conclusions This study shows a very low rate of VL suppression in a semi-rural context in Africa. Moreover, the high burden of HIVDR has affected both current and newly recommended ART strategies. Better management of ART in resource-limited settings is still a challenging ambition.

scholarly journals High-Levels of Acquired Drug Resistance in Adult Patients Failing First-Line Antiretroviral Therapy in a Rural HIV Treatment Programme in KwaZulu-Natal, South Africa

PLoS ONE ◽  
2013 ◽  
Vol 8 (8) ◽  
pp. e72152 ◽  
Author(s):  
Justen Manasa ◽  
Richard J. Lessells ◽  
Andrew Skingsley ◽  
Kevindra K. Naidu ◽  
Marie-Louise Newell ◽  
...  
Keyword(s):  
South Africa ◽  
Drug Resistance ◽  
Antiretroviral Therapy ◽  
Hiv Treatment ◽  
Adult Patients ◽  
Treatment Programme ◽  
First Line ◽  
Acquired Drug Resistance ◽  
Kwazulu Natal

scholarly journals High HIV-1 Virological Failure and Drug Resistance among Adult Patients Receiving First-Line ART for At least 12 Months at a Decentralized Urban HIV Clinic Setting in Senegal before the Test-and-Treat

2021 ◽  
Vol 14 ◽  
pp. 117863372110145
Author(s):  
Aristid Ekollo Mbange ◽  
Abou Abdallah Malick Diouara ◽  
Halimatou Diop-Ndiaye ◽  
Ndèye Aminata Diaw Diouf ◽  
Ndèye Fatou Ngom-Ngueye ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Virological Failure ◽  
Sub Saharan Africa ◽  
Treatment Center ◽  
First Line ◽  
Hiv Diagnosis ◽  
Saint Louis ◽  
Test And Treat ◽  
Adherence Support ◽  
Hiv 1

Background: The feasibility of antiretroviral therapy (ART) monitoring remains problematic in decentralized HIV clinic settings of sub-Saharan Africa. We assessed the rates and correlates of HIV-1 virological failure (VF) and drug resistance (DR) in 2 pre-test-and-treat urban clinic settings of Senegal. Methods: Consenting HIV-1-infected adults (⩾18 years) receiving first-line ART for ⩾12 months were cross-sectionally enrolled between January and March 2015, at the referral outpatient treatment center of Dakar (n = 151) and decentralized regional hospital of Saint-Louis (n = 127). In the 12 months preceding plasma specimens’ collection patients at Saint-Louis had no viral load (VL) testing. Significant predictors of VF (VL ⩾ 1000 copies/ml) and DR (clinically relevant mutations) were determined using binomial logistic regression in R software. Results: Of the 278 adults on EFV-/NVP-based regimens, 32 (11.5% [95%CI: 8.0-15.9]) experienced VF. Failing and non-failing patients had comparable median time [interquartile] on ART (69.5 [23.0-89.5] vs 64.0 [34.0-99.0] months; P = .46, Mann–Whitney U-test). Of the 27 viraemic isolates successfully genotyped, 20 (74.1%) carried DR mutations; most frequent were M184VI (55.6%), K103N (37.1%), thymidine analog mutations (29.6%), Y181CY (22.2%). The pattern of mutations did not always correspond to the ongoing treatment. The adjusted odds of VF was significantly associated with the decentralized clinic site ( P < .001) and CD4 < 350 cells/mm3 ( P < .006). Strong correlates of DR also included Saint-Louis ( P < .009), CD4 < 350 cells/mm3 ( P <. 001), and nevirapine-based therapies (comparator: efavirenz-based therapies; P < .027). In stratification analyses by site, higher rate of VF at Saint-Louis (20.5% [95%CI: 13.8-28.5] vs 4.0% [95%CI: 1.5-8.5] in Dakar) was associated with nevirapine-based therapies (OR = 3.34 [1.07-11.75], P = .038), self-reported missing doses (OR = 3.30 [1.13-10.24], P = .029), and medical appointments (OR = 2.91 [1.05-8.47], P = .039) in the last 1 and 12 months(s), respectively. The higher rate of DR at Saint-Louis (12.9% [95%CI: 7.6-20.1] vs 2.7% [95%CI: 0.7-6.7] in Dakar) was associated with nevirapine-based therapies (OR = 5.13 [1.12-37.35], P = .035). Conclusion: At decentralized urban settings, there is need for enhanced virological monitoring and adherence support. HIV programs in Senegal should intensify early HIV diagnosis for effective test-and-treat. These interventions, in addition to the superiority of efavirenz-based therapies provide a favorable framework for transitioning to the recommended potent drug dolutegravir, thereby ensuring its long-term use.

scholarly journals Antituberculous Drug Resistance in Western Canada (1993 to 1994)

1997 ◽  
Vol 4 (2) ◽  
pp. 71-75 ◽  
Author(s):  
Richard Long ◽  
Anne Fanning ◽  
Robert Cowie ◽  
Vernon Hoeppner ◽  
Mark Fitzgerald ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Drug Susceptibility Testing ◽  
Resistance Rate ◽  
Western Canada ◽  
Drug Resistant ◽  
Foreign Born ◽  
First Line ◽  
Acquired Drug Resistance ◽  
Antituberculous Drug ◽  
Culture Positive

OBJECTIVES: To estimate the magnitude of antituberculous drug resistance and identify prospectively the risk factors for its development in tuberculosis (TB) patients in western Canada over a one-year period.DESIGN: Comparison of drug-resistant and nondrug-resistant cases of TB.SETTING: Western Canada.PATIENTS: All people with TB reported to the TB registries of Manitoba, British Columbia, Alberta and Saskatchewan between February 1, 1993 and January 31, 1994.MAIN OUTCOME MEASURES: Drug susceptibility testing was performed in all cases of culture-positive tuberculosis. Patients at risk for human immunodeficiency virus (HIV) infection were serotested.RESULTS: Of 534 culture positive cases of TB, 37 (6.9%) were drug resistant. Odds ratios suggested that the risk of drug resistance was significantly higher among those with reactivation than among those with new disease, and among those born outside of Canada than among those born in Canada. Ninety per cent of the foreign-born patients with drug-resistant disease were from Asia. Of the 35 patients with drug resistance whose type of resistance was known, 76% had initial and 24% had acquired drug resistance. The initial resistance rate in Asian-born patients was 14%. Most of the 37 drug-resistant cases were resistant to isoniazid (68%), streptomycin (49%) or both (22%). Twelve (32%) of the 37 cases were resistant to two or more first-line drugs. Of 14 patients who were HIV seropositive only one, a foreign-born patient, was drug resistant.CONCLUSION: Antituberculous drug resistance is low among Canadian-born patients in western Canada, but not uncommon among those born outside Canada. Initial therapy of foreign-born patients should include four first-line drugs.

scholarly journals Group counselling for adherence support among young people failing first-line antiretroviral therapy in Zimbabwe

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Bahati Kasimonje ◽  
Tinei Shamu ◽  
Tinahe Mudzviti ◽  
Ruedi Luethy
Keyword(s):  
Antiretroviral Therapy ◽  
Young People ◽  
Group Intervention ◽  
People Living With Hiv ◽  
First Line ◽  
Viral Loads ◽  
Adherence Support ◽  
Adherence Counselling ◽  
Lost To Follow Up

Background: Sub-optimal adherence to antiretroviral therapy (ART) is reportedly worse amongst young people living with HIV (YPLHIV). Group adherence counselling can be useful to improve adherence.Objectives: We evaluated an enhanced adherence counselling group intervention (EACGI) amongst YPLHIV failing a non-nucleoside reverse transcriptase (NNRTI)-based first-line ART regimen.Method: This was a retrospective cohort study using routinely collected data of YPLHIV failing NNRTI-based first-line ART. Patients with confirmed virological failure were referred for EACGI, a 12-week curriculum of weekly, 1.5-h sessions accommodating 8–15 people per group. It aimed to facilitate readiness to switch to second-line ART and improve adherence through a mental health intervention. Viral loads of HIV were measured pre-EACGI; at baseline; 3, 6 and 12 months post switch.Results: Fifty-seven patients aged 13–25 years were invited to EACGI and followed for up to 48 weeks. Thirty-three (58%) patients attended at least four sessions, whilst 24 (42%) attended none. Amongst those who attended none, two (8%) were transferred out, three (13%) were lost to follow-up and two (8%) had died by week 48 of follow-up, whilst all who attended were still in care. By week 48, amongst patients still in care, 29%, 44% and 67% of those who attended no sessions, 4–9 and 10–12 sessions, respectively, had viral loads of 50 copies/mL.Conclusion: An EACGI is a promising intervention for YPLHIV failing ART prior to treatment switch, leading to improved adherence. This study’s findings support the need for further enquiry into rigorous, evidence-based multilevel adherence interventions that are acceptable and effective for YPLHIV.

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