Eight-day Inpatient Directly Observed Therapy for Antiretroviral Therapy (ART) Failure: A Tool For Preventing Unnecessary ART Changes and Optimizing Adherence Support

Abstract Eight-day inpatient directly observed therapy confirmed nonadherence as the major cause of virologic failure for 9 (45%) of 20 highly treatment-experienced persons with human immunodeficiency virus, extensive antiretroviral drug resistance, and high self-reported adherence rates, preventing unnecessary regimen changes.

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Virologic Failure and Human Immunodeficiency Virus Drug Resistance in Rural Cameroon With Regard to the UNAIDS 90-90-90 Treatment Targets

Open Forum Infectious Diseases ◽

10.1093/ofid/ofw233 ◽

2016 ◽

Vol 3 (4) ◽

Cited By ~ 6

Author(s):

Charlotte Boullé ◽

Emilande Guichet ◽

Charles Kouanfack ◽

Avelin Aghokeng ◽

Benjamin Onambany ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Drug Resistance ◽

Viral Load ◽

Virologic Failure ◽

Reverse Transcriptase Inhibitors ◽

Treatment Targets ◽

Antiretroviral Drug Resistance ◽

Antiretroviral Drug ◽

Immunodeficiency Virus ◽

Rural Cameroon

Abstract Background In rural Africa, data on virologic effectiveness of antiretroviral treatment (ART) are not sufficient to assess the gap with the UNAIDS 90-90-90 treatment targets. We investigated the prevalences of unsuppressed viral load and antiretroviral drug resistance and the profile of genotypic resistance mutations among patients routinely treated in rural Cameroon. Methods A cross-sectional study was performed in 2013–2014 among patients ≥15 years and on first-line ART for ≥6 months in a district hospital. Patients were offered free access to human immunodeficiency virus viral load testing. Genotypic drug resistance testing was done when the viral load was >1000 copies/mL. Multivariate logistic regression models were used to assess the relationship of unsuppressed viral load or antiretroviral drug resistance with sociodemographic and medical characteristics. Results Of 407 patients (women 74.9%, median age 41.8 years, median time on ART 29.2 months), 96 (23.6%; 95% confidence interval [CI], 19.5–28.0) had unsuppressed viral load and 74 (18.2%; 95% CI, 14.6–22.3) had antiretroviral drug resistance. The prevalences of unsuppressed viral load and resistance increased with time on ART, from 12.0% and 8.0% in the 6- to 12-month group to 31.3% and 27.1% in the >72-month group, respectively. All 74 patients with antiretroviral drug resistance were resistant to nonnucleoside reverse-transcriptase inhibitors, and 57 of them were also resistant to nucleoside reverse-transcriptase inhibitors. Conclusions Our estimations were among the highest observed in the west and central African region. The proportion of patients with virologic failure should be divided at least by 2 to reach the UNAIDS 90-90-90 treatment targets.

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A qualitative PCR minipool strategy to screen for virologic failure and antiretroviral drug resistance in South African patients on first-line antiretroviral therapy

Journal of Clinical Virology ◽

10.1016/j.jcv.2014.05.011 ◽

2014 ◽

Vol 60 (4) ◽

pp. 387-391 ◽

Cited By ~ 8

Author(s):

Howard Newman ◽

Lukas Breunig ◽

Gert van Zyl ◽

August Stich ◽

Wolfgang Preiser

Keyword(s):

Drug Resistance ◽

Antiretroviral Therapy ◽

South African ◽

Virologic Failure ◽

First Line ◽

Antiretroviral Drug Resistance ◽

Antiretroviral Drug ◽

African Patients ◽

Qualitative Pcr

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Primary Antiretroviral Drug Resistance in Newly Human Immunodeficiency Virus-Diagnosed Individuals Testing Anonymously and Confidentially

Microbial Drug Resistance ◽

10.1089/mdr.2010.0066 ◽

2011 ◽

Vol 17 (2) ◽

pp. 283-289 ◽

Cited By ~ 3

Author(s):

Amanda R. Markovitz ◽

Christina S. Thibault ◽

Peter W. Brandauer ◽

Susan E. Buskin

Keyword(s):

Human Immunodeficiency Virus ◽

Drug Resistance ◽

Antiretroviral Drug Resistance ◽

Antiretroviral Drug ◽

Immunodeficiency Virus

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Trends of antiretroviral drug resistance in treatment-naive patients with human immunodeficiency virus type 1 infection in Taiwan

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkn002 ◽

2008 ◽

Vol 61 (3) ◽

pp. 689-693 ◽

Cited By ~ 23

Author(s):

S.-Y. Chang ◽

M.-Y. Chen ◽

C.-N. Lee ◽

H.-Y. Sun ◽

W. Ko ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Drug Resistance ◽

Human Immunodeficiency Virus Type ◽

Virus Type ◽

Antiretroviral Drug Resistance ◽

Antiretroviral Drug ◽

Immunodeficiency Virus ◽

Treatment Naïve

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Compromise of Second-Line Antiretroviral Therapy Due to High Rates of Human Immunodeficiency Virus Drug Resistance in Mozambican Treatment-Experienced Children With Virologic Failure

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piy102 ◽

2018 ◽

Author(s):

Paula Vaz ◽

W Chris Buck ◽

Nilesh Bhatt ◽

Dulce Bila ◽

Andrew Auld ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Drug Resistance ◽

Antiretroviral Therapy ◽

Virologic Failure ◽

Second Line ◽

Immunodeficiency Virus ◽

Second Line Antiretroviral Therapy

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Diverse Human Immunodeficiency Virus–1 Drug Resistance Profiles at Screening for ACTG A5288: A Study of People Experiencing Virologic Failure on Second-line Antiretroviral Therapy in Resource-limited Settings

Clinical Infectious Diseases ◽

10.1093/cid/ciz1116 ◽

2019 ◽

Vol 71 (7) ◽

pp. e170-e177 ◽

Cited By ~ 2

Author(s):

Carole L Wallis ◽

Michael D Hughes ◽

Justin Ritz ◽

Raquel Viana ◽

Carlos Silva de Jesus ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Drug Resistance ◽

Antiretroviral Therapy ◽

Virologic Failure ◽

Cd4 T Cell ◽

Second Line ◽

Drug Classes ◽

Immunodeficiency Virus ◽

Third Line ◽

Second Line Antiretroviral Therapy

Abstract Background Human immunodeficiency virus (HIV) drug resistance profiles are needed to optimize individual patient management and to develop treatment guidelines. Resistance profiles are not well defined among individuals on failing second-line antiretroviral therapy (ART) in low- and middle-income countries (LMIC). Methods Resistance genotypes were performed during screening for enrollment into a trial of third-line ART (AIDS Clinical Trials Group protocol 5288). Prior exposure to both nucleoside reverse transcriptase inhibitors (NRTIs) and non-NRTIs and confirmed virologic failure on a protease inhibitor–containing regimen were required. Associations of drug resistance with sex, age, treatment history, plasma HIV RNA, nadir CD4+T-cell count, HIV subtype, and country were investigated. Results Plasma HIV genotypes were analyzed for 653 screened candidates; most had resistance (508 of 653; 78%) to 1 or more drugs. Genotypes from 133 (20%) showed resistance to at least 1 drug in a drug class, from 206 (32%) showed resistance to at least 1 drug in 2 drug classes, and from 169 (26%) showed resistance to at least 1 drug in all 3 commonly available drug classes. Susceptibility to at least 1 second-line regimen was preserved in 59%, as were susceptibility to etravirine (78%) and darunavir/ritonavir (97%). Susceptibility to a second-line regimen was significantly higher among women, younger individuals, those with higher nadir CD4+ T-cell counts, and those who had received lopinavir/ritonavir, but was lower among prior nevirapine recipients. Conclusions Highly divergent HIV drug resistance profiles were observed among candidates screened for third-line ART in LMIC, ranging from no resistance to resistance to 3 drug classes. These findings underscore the need for access to resistance testing and newer antiretrovirals for the optimal management of third-line ART in LMIC.

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