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J Antimicrob Chemother. 2018 Nov 21. doi: 10.1093/jac/dky436. [Epub ahead of print]

Importance of routine viral load monitoring: higher levels of resistance at ART failure in Uganda and Lesotho compared with Switzerland.

Author information

1
Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
2
Institute of Medical Virology, University of Zurich, Zurich, Switzerland.
3
Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.
4
Swiss Tropical and Public Health Institute, Basel, Switzerland.
5
University of Basel, Basel, Switzerland.
6
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
7
SolidarMed, Swiss Organization for Health in Africa, Butha-Buthe, Lesotho.
8
Laboratory of Virology, University Hospital Geneva, University of Geneva, Geneva, Switzerland.
9
Division of Immunology and Allergy, CHUV, Lausanne, Switzerland.
10
Department of Public Health at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.

Abstract

Objectives:

Emerging resistance to antiretroviral drugs may jeopardize the achievements of improved access to ART. We compared the prevalence of different resistance mutations in HIV-infected adults with virological failure in a cohort with regular routine viral load (VL) monitoring (Switzerland) and cohorts with limited access to VL testing (Uganda and Lesotho).

Methods:

We considered individuals who had genotypic resistance testing (GRT) upon virological failure (≥1000 copies/mL) and were on ART consisting of at least one NNRTI and two NRTIs. From Lesotho, individuals with two subsequent VLs ≥1000 copies/mL despite enhanced adherence counselling (n = 58) were included in the analysis. From Uganda, individuals with a single VL ≥1000 copies/mL (n = 120) were included in the analysis. From the Swiss HIV Cohort Study (SHCS), a population without history of monotherapy or dual therapy with the first GRT upon virological failure (n = 61) was selected.

Results:

We found that 50.8% of individuals in the SHCS, 72.5% in Uganda and 81.0% in Lesotho harboured HIV with high-level resistance to at least two drugs from their current regimen. Stanford resistance scores were higher in Uganda compared with Switzerland for all drugs used in first-line treatment except zidovudine and tenofovir (P < 0.01) and higher in Lesotho compared with Uganda for all drugs used in first-line treatment except zidovudine (P < 0.01).

Conclusions:

Frequent VL monitoring and possibly pretreatment GRT as done in the SHCS pays off by low levels of resistance even when treatment failure occurs. The high-level resistance patterns in Lesotho compared with Uganda could reflect a selection of strains with multiple resistance during enhanced adherence counselling.

PMID:
30476115
DOI:
10.1093/jac/dky436

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