Importance of routine viral load monitoring: higher levels of resistance at ART failure in Uganda and Lesotho compared with Switzerland.
- Bachmann N Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
- von Braun A Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
- Labhardt ND Swiss Tropical and Public Health Institute, Basel, Switzerland.
- Kadelka C Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
- Günthard HF Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
- Sekaggya-Wiltshire C Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.
- Castelnuovo B Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.
- Kambugu A Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.
- Lejone TI SolidarMed, Swiss Organization for Health in Africa, Butha-Buthe, Lesotho.
- Böni J Institute of Medical Virology, University of Zurich, Zurich, Switzerland.
- Yerly S Laboratory of Virology, University Hospital Geneva, University of Geneva, Geneva, Switzerland.
- Perreau M Division of Immunology and Allergy, CHUV, Lausanne, Switzerland.
- Klimkait T University of Basel, Basel, Switzerland.
- Kouyos RD Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
- Fehr J Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
- 2018-11-27
Published in:
- The Journal of antimicrobial chemotherapy. - 2019
Adolescent
Adult
Anti-HIV Agents
Cohort Studies
Cross-Sectional Studies
Drug Resistance, Viral
Female
Genotype
HIV Infections
HIV-1
Humans
Lesotho
Male
Middle Aged
Prevalence
Switzerland
Treatment Failure
Uganda
Viral Load
Young Adult
English
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.
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.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1093/jac/dky436
- PMID 30476115
- Persistent URL
- https://sonar.ch/global/documents/255883
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