Prevalence of viral load suppression, predictors of virological failure and patterns of HIV drug resistance after 12 and 48 months on first-line antiretroviral therapy: a national cross-sectional survey in Uganda

Abstract

Objectives We implemented the WHO cross-sectional survey protocol to determine rates of HIV viral load (VL) suppression (VLS), and weighted prevalence, predictors and patterns of acquired drug resistance (ADR) in individuals with virological failure (VF) defined as VL ≥1000 copies/mL. Methods We enrolled 547 and 1064 adult participants on first-line ART for 12 (±3) months (ADR12) and ≥48 months (ADR48), respectively. Dried blood spots and plasma specimens were collected for VL testing and genotyping among the VFs. Results VLS was 95.0% (95% CI 93.4%–96.5%) in the ADR12 group and 87.9% (95% CI 85.0%–90.9%) in the ADR48 group. The weighted prevalence of ADR was 96.1% (95% CI 72.9%–99.6%) in the ADR12 and 90.4% (95% CI 73.6–96.8%) in the ADR48 group, out of the 30 and 95 successful genotypes in the respective groups. Initiation on a zidovudine-based regimen compared with a tenofovir-based regimen was significantly associated with VF in the ADR48 group; adjusted OR (AOR) 1.96 (95% CI 1.13–3.39). Independent predictors of ADR in the ADR48 group were initiation on a zidovudine-based regimen compared with tenofovir-based regimens, AOR 3.16 (95% CI 1.34–7.46) and ART duration of ≥82 months compared with <82 months, AOR 1.92 (95% CI 1.03–3.59). Conclusions While good VLS was observed, the high prevalence of ADR among the VFs before they underwent the recommended three intensive adherence counselling (IAC) sessions followed by repeat VL testing implies that IAC prior to treatment switching may be of limited benefit in improving VLS.

Viral suppression among HIV-positive patients on antiretroviral therapy in northwestern Nigeria: an eleven-year review of tertiary care centre records, January 2009–December 2019

“…The value of viral suppression in this study was also higher compared to 79% reported in a multi-center Nigerian study [ 8 ], and 84% in Borno state, north-eastern Nigeria [ 9 ], 69% in Ghana [ 10 ] and 73% in northern Ethiopia [ 11 ]. High level of viral suppression in this study are comparable with the reports from Uganda where a level of 95% was observed for viral suppression after 12 months of HAART among PLHIV [ 12 ]. Similarly, the level of viral non-suppression obtained in this study is comparable to 9.0% and 7.0% reported in the African cohort study [ 13 ], and Vietnam [ 14 ] respectively.…”

Virological Non-Suppression Among HIV-Positive Patients on Antiretroviral Therapy in Northwestern Nigeria: An Eleven-Year Experience of A Tertiary Care Centre, January 2009–December 2019

“…The value of viral suppression in this study is also higher compared with 79% in a multi-center Nigerian study [8], and 84% in Borno state in north-eastern Nigeria [9], 69% in Ghana [10] and 73% in northern Ethiopia [11]. Our findings of a high level of viral suppression are comparable with the reports from Uganda where a level viral suppression of 95% was observed after 12 months of HAART among PLHIV [12]. Similarly, the level of viral non-suppression obtained in this study is comparable to 9.0% reported in the African cohort study [13], and 7.0% reported in Vietnam [14] after at least 12 months of HAART.…”

HIV-1 drug resistance genotyping success rates and correlates of Dried-blood spots and plasma specimen genotyping failure in a resource-limited setting

“…Interestingly, in our study, a substantial proportion of both DBS and plasma specimens had VL<10,000 copies/mL. This implies that in this era when virological suppression (VL<1000 copies/mL) rates nearing or exceeding 90% have been observed [36,40], and following recommendations to use more potent dolutegravir-containing regimens, genotyping success rates are likely to continue to decline. There is evidence in this study that shows median viral loads of specimens analysed in our laboratory rapidly decreasing from 2016 to 2019.…”

“…There is evidence in this study that shows median viral loads of specimens analysed in our laboratory rapidly decreasing from 2016 to 2019. This can be explained by rapid scale-up of ART following recommendations of the WHO and subsequent high VL suppression rates reported in our setting [40]. What is more intriguing is that even at VL<1000 copies/mL, HIVDR variants can still be selected as reported in a Kenyan study in which plasma samples with VL£1000 copies/mL had a genotyping success rate of 32% [49].…”

“…This popularity should be followed by precautions to ensure that specimen quality is not compromised on the way to the laboratory for genotyping. Evidence from other studies suggests that DBS specimen yield appreciable genotyping rates when specimens are properly handled to ensure nucleic acid integrity [37,40].…”