Impact of HIV drug resistance on virologic and immunologic failure and mortality in a cohort of patients on antiretroviral therapy in China

Abstract

Objectives:To study the dynamics of HIV drug resistance (HIVDR) and its association with virologic and immunologic failure as well as mortality among patients on combination antiretroviral therapy (cART) in China.Design:We recruited 365 patients on cART in two rural Chinese counties in 2003–2004 and followed them every 6 months until May 2010.Methods:Virologic failure, HIVDR, immunologic failure and death were documented. We used Kaplan–Meier and the proportional hazards models to identify the timing of the events, and risk factors for mortality.Results:At the end of study, patients had been followed for 1974.3 person-years, a median of 6.1 years. HIVDR mutations were found in 235 (64.4%) patients and 75 died (20.5%, 3.8/100 person-years). Median time from cART to detection of virologic failure was 17.5 months, to HIVDR 36.6 months and to immunologic failure 55.2 months (≈18-month median interval between each adverse milestone). Being male, having a baseline CD4+ cell count of less than 50 cells/μl and HIVDR were associated with higher mortality. Patients who developed HIVDR in the first year of treatment had higher mortality than those developing HIVDR later (adjusted hazard ratio 1.90, 95% confidence interval 1.01–3.48).Conclusion:HIVDR was common and was associated with higher mortality among Chinese patients on cART, particular when HIVDR was detected early in therapy. Our study reinforces the importance of improving patient adherence to cART in order to delay the emergence of HIVDR and obviate the need to switch to costly second-line drug regimens too early.

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

“…30 Our findings are in agreement with the WHO recommendations for HIV viral load testing in resource-limited settings, which suggest that patients with low viraemia should undergo intensified adherence interventions to regain HIV-1 RNA suppression without switching ART, 31 and those with repeated high viral load measures should be switched to second-line ART without delay. 32,33 Interestingly, we did not detect the K65R mutation, which reduces the susceptibility to tenofovir disoproxil fumarate, despite the fact that one-third of patients with detectable HIV-DRM had been on a tenofovir-based regimen for a minimum of 6 months. K65R is the most important discriminatory mutation, causing intermediate resistance to tenofovir, while increasing the susceptibility to zidovudine, and is mostly selected in patients with HIV subtype C. 34 Our observation provides relevant preliminary information on the mutational patterns among patients under the current WHO guideline recommendations for tenofovir-based regimens.…”

Predictors of treatment failure on second-line antiretroviral therapy among adults in northwest Ethiopia: a multicentre retrospective follow-up study

“…Though frequently effective, standard first-line regimens do not work for everyone, particularly if they are infected with a drug-resistant strain of the virus12 and/or have poor adherence 1314 Other predictors for treatment failure of first-line treatments include: older age,10 15 male sex,10 11 16 severe malnutrition,10 17 anaemia9 10 18 low baseline CD4 cell count,10 16 19 advanced baseline WHO clinical stage,16 20 21 longer duration of ART intake,22 and a negative change in body weight 23…”

Factors Associated with Non-Adherence to Antiretroviral Therapy among Adults living with HIV/AIDS in Arsi Zone, Oromia

“…Treatment efficacy relies, however, on sustained adherence, which constitutes a serious challenge to those receiving antiretroviral therapy [3]. The regimens are often complicated and can include varying dosing schedules, dietary restrictions, and adverse effects [4].Consistently high levels of adherence are necessary for reliable viral suppression [5] and prevention of resistance [6], disease progression, and death [7]. Even though antiretroviral therapy is the single most dramatic development yet in the treatment of HIV/ AIDS, many have been described as inconsistent with their treatment regimens [8,9].…”