Effect of pretreatment HIV-1 drug resistance on immunological, virological, and drug-resistance outcomes of first-line antiretroviral treatment in sub-Saharan Africa: a multicentre cohort study

Summary Background The effect of pretreatment HIV-1 drug resistance on the response to first-line combination antiretroviral therapy (ART) in sub-Saharan Africa has not been assessed. We studied pretreatment drug resistance and virological, immunological, and drug-resistance treatment outcomes in a...

Full description

Saved in:
Bibliographic Details
Published in:The Lancet infectious diseases 2012-04, Vol.12 (4), p.307-317
Main Authors: Hamers, Raph L, Dr, Schuurman, Rob, PhD, Sigaloff, Kim CE, MD, Wallis, Carole L, PhD, Kityo, Cissy, MD, Siwale, Margaret, MRCP, Mandaliya, Kishor, MBChB, Ive, Prudence, MD, Botes, Mariette E, MD, Wellington, Maureen, MBChB, Osibogun, Akin, Prof, Wit, Ferdinand W, MD, van Vugt, Michèle, MD, Stevens, Wendy S, Prof, de Wit, Tobias F Rinke, Prof
Format: Article
Language:English
Subjects:
Adult
Africa South of the Sahara
Algorithms
Anti-HIV Agents - administration & dosage
Antibiotics. Antiinfectious agents. Antiparasitic agents
antiretroviral therapy
Antiviral agents
Biological and medical sciences
CD4 antigen
CD4 Lymphocyte Count
Cohort Studies
Data processing
Drug resistance
Drug Resistance, Viral
Female
HIV Infections - drug therapy
HIV Infections - immunology
HIV Infections - virology
HIV-1 - genetics
HIV-1 - immunology
Human immunodeficiency virus 1
Human viral diseases
Humans
Immunodeficiencies
Immunodeficiencies. Immunoglobulinopathies
Immunopathology
Infectious Disease
Infectious diseases
Logistic Models
Male
Medical sciences
Mutation
Pharmacology. Drug treatments
Prospective Studies
Reverse Transcriptase Inhibitors - administration & dosage
Risk factors
RNA, Viral - blood
RNA-directed DNA polymerase
Viral diseases
Viral diseases of the lymphoid tissue and the blood. Aids
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Summary Background The effect of pretreatment HIV-1 drug resistance on the response to first-line combination antiretroviral therapy (ART) in sub-Saharan Africa has not been assessed. We studied pretreatment drug resistance and virological, immunological, and drug-resistance treatment outcomes in a large prospective cohort. Methods HIV-1 infected patients in the PharmAccess African Studies to Evaluate Resistance Monitoring (PASER-M) cohort started non-nucleoside reverse transcriptase inhibitor-based ART at 13 clinical sites in six countries, from 2007 to 2009. We used the International Antiviral Society-USA drug resistance mutation list and the Stanford algorithm to classify participants into three pretreatment drug resistance categories: no pretreatment drug resistance, pretreatment drug resistance with fully active ART prescribed, or pretreatment drug resistance with reduced susceptibility to at least one prescribed drug. We assessed risk factors of virological failure (≥400 copies per mL) and acquired drug resistance after 12 months of ART by use of multilevel logistic regression with multiple imputations for missing data. CD4 cell count increase was estimated with linear mixed models. Findings Pretreatment drug resistance results were available for 2579 (94%) of 2733 participants; 2404 (93%) had no pretreatment drug resistance, 123 (5%) had pretreatment drug resistance to at least one prescribed drug, and 52 (2%) had pretreatment drug resistance and received fully active ART. Compared with participants without pretreatment drug resistance, the odds ratio (OR) for virological failure (OR 2·13, 95% CI 1·44–3·14; p
ISSN:1473-3099
1474-4457
DOI:10.1016/S1473-3099(11)70255-9