Clinical and virological response to antiretroviral drugs among HIV patients on first-line treatment in Dar-es-Salaam, Tanzania

Abstract

Introduction: In Tanzania, the follow-up on antiretroviral therapy (ART) response is based on clinical outcomes. We investigated virological response and ARV resistance mutations in relation to clinical response in ARV-treated patients. Methodology: A cross-sectional study of a cohort of 150 patients taking first-line ART in Dar-es-Salaam was conducted. Data were collected using standardized questionnaires and patients' blood samples. HIV viral load testing and genotyping was performed on all viremic samples. Statistical analyses compared clinical responders and non-responders. Results: The median time on ART was 20 months; 71 (47%) patients were ART clinical responders. Clinical non-responders were more likely to have started ART with advanced disease with significantly lower median percentage weight gain (6% versus 20%) with respect to pre-treatment levels. Sixty-one (86%) and 64 (81%) of clinical responders and non-responders, respectively, had undetectable viral loads. Genotyping was successful in 24 (96%) virologically failing patients, among whom 83% had resistance mutations; 67% had dual nucleoside reverse transcriptase inhibitor (NRTI)/non-NRTI (NNRTI) resistance mutations. Seventeen (71%) and 19 (79%) patients had NRTI and NNRTI resistance mutations, respectively, which were related to the ART in use, with no difference between clinical responders and nonresponders. The most prevalent subtypes were A and C, found in 9 (38%) and 7 (29%) patients, respectively. Conclusions: The observed virological response was high and did not correlate with clinical response. The prevalence of ARV resistance mutations was high in viraemic patients and was related to the ARV prescribed. We recommend use of viral load monitoring during ART in Tanzania.

Factors Influencing Antiretroviral Adherence and Virological Outcomes in People Living with HIV in the Highlands of Papua New Guinea

“…A similar study performed in Dar-es-Salaam, Tanzania, reported 15% virological failure rates amongst patients who have been on ART for a median of 20 months. [ 38 ] Our study found that participants who had higher levels of education or held formal employment were more likely to experience virological failure; however, we acknowledge that the number of participants who had secondary school and tertiary education or formal employment was small (n = 13). Conversely, participants who had heard of drug resistance and those whose treatment regimen has been constant since initiation ART were significantly less likely to have virological failure.…”

HIV virological failure and drug resistance in a cohort of Tanzanian HIV-infected adults

“…3,7,25,27,33 -36 Minor PI DRMs were observed in 27 patients, similar to what has been observed in other Tanzanian settings. 37 Only one of the PI mutations (V82T/S) is known to be associated with reduced susceptibility to PIs (atazanavir, indinavir, lopinavir and tipranavir) and potentially could have impacted second-line therapy in this patient. To our knowledge, none of the patients had received any ART regimen prior to enrolment into the parent TOV3 study, suggesting that these PI mutations were transmitted rather than acquired.…”

Strengthening HIV therapy and care in rural Tanzania affects rates of viral suppression

“…24,28 To our knowledge, this is the first well-powered study addressing virological effectiveness and the emergence of HIV-DRM among patients on the current WHO-recommended ART regimen in Tanzania under programmatic conditions. Our findings provide further evidence from rural African settings that higher virological suppression rates can be achieved when HIV treatment and care programmes are continuous and effectively managed.…”