The relative contributions of HIV drug resistance, nonadherence and low-level viremia to viremic episodes on antiretroviral therapy in sub-Saharan Africa.

AIDS
Seth InzauleRaph L Hamers

Abstract

To achieve viral suppression among more than 90% of people on antiretroviral therapy (ART), improved understanding is warranted of the modifiable causes of HIV viremic episodes. We assessed the relative contributions of drug-resistance, nonadherence and low-level viremia (LLV) (viral load 50-999 cps/ml) on viremic episodes in sub-Saharan Africa. In a multicountry adult cohort initiating nonnucleoside reverse transcriptase inhibitor-based first-line ART, viremic episodes (viral load ≥1000 cps/ml) were classified as first, viral nonsuppression at 12 months; second, virological rebound at 24 months (after initial viral suppression at 12 months); third, failure to achieve viral resuppression at 24 months (after viremic episode at 12 months). We used adjusted odds ratios from multivariable logistic regression to estimate attributable fractions for each risk factor. Of 2737 cohort participants, 1935 had data on pretreatment drug resistance (PDR) and at least 1 viral load outcome. Viral nonsuppression episodes [173/1935 (8.9%)] were attributable to nonadherence in 30% (35% in men vs. 24% in women) and to PDR to nonnucleoside reverse transcriptase inhibitors in 10% (15% in women vs. 6% in men). Notably, at contemporary PDR prevalences ...Continue Reading

References

Nov 17, 2009·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Christopher J HoffmannAlison D Grant
Nov 1, 2011·The Lancet Infectious Diseases·Raph L HamersUNKNOWN PharmAccess African Studies to Evaluate Resistance (PASER) Investigators
Jun 19, 2013·Journal of Acquired Immune Deficiency Syndromes : JAIDS·Kimberly BonnerJennifer Cohn
Apr 16, 2014·Antimicrobial Agents and Chemotherapy·Patrick RyscavageBabafemi Taiwo
Sep 24, 2015·BMC Infectious Diseases·Jim YoungUNKNOWN Swiss HIV Cohort Study
Oct 5, 2018·The Lancet. HIV·Seth C InzauleUNKNOWN PanAfrican Studies to Evaluate Resistance
Oct 16, 2018·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Anne DeracheDeenan Pillay
Dec 19, 2018·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Seth C InzauleUNKNOWN Pan-African Studies to Evaluate Resistance
Mar 17, 2019·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Landon MyerSteven J Reynolds

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