Clinical and virological response to antiretroviral drugs among HIV patients on first-line treatment in Dar-es-Salaam, Tanzania.

Fausta Mosha,Faustine Ndugulile,Peter Nsubuga,Andrew Swai,Johanna Ledwaba,Zipora Ng’Ang’A,Lynn Morris,Jurgen Vercauteren,Mabula Kasubi,Anne-Mieke Vandamme

doi:10.3855/jidc.3879

Abstract

In Tanzania, the follow-up on antiretroviral therapy (ART) response is based on clinical outcomes. We investigated virological response and ARV resistance mutations in relation to clinical response in ARV-treated patients. A cross-sectional study of a cohort of 150 patients taking first-line ART in Dar-es-Salaam was conducted. Data were collected using standardized questionnaires and patients' blood samples. HIV viral load testing and genotyping was performed on all viremic samples. Statistical analyses compared clinical responders and non-responders. The median time on ART was 20 months; 71 (47%) patients were ART clinical responders. Clinical non-responders were more likely to have started ART with advanced disease with significantly lower median percentage weight gain (6% versus 20%) with respect to pre-treatment levels. Sixty-one (86%) and 64 (81%) of clinical responders and non-responders, respectively, had undetectable viral loads. Genotyping was successful in 24 (96%) virologically failing patients, among whom 83% had resistance mutations; 67% had dual nucleoside reverse transcriptase inhibitor (NRTI)/non-NRTI (NNRTI) resistance mutations. Seventeen (71%) and 19 (79%) patients had NRTI and NNRTI resistance mutations, respectively, which were related to the ART in use, with no difference between clinical responders and non-responders. The most prevalent subtypes were A and C, found in 9 (38%) and 7 (29%) patients, respectively. The observed virological response was high and did not correlate with clinical response. The prevalence of ARV resistance mutations was high in viraemic patients and was related to the ARV prescribed. We recommend use of viral load monitoring during ART in Tanzania.

Highlights

In Tanzania, the follow-up on antiretroviral therapy (ART) response is based on clinical outcomes
Eligibility of patients for ART was as recommended by the Tanzania HIV/AIDS care and treatment guidelines [4]
We could not thoroughly assess the association between therapy response and resistance pattern because of our small sample size and the different HIV-1 subtypes, but we found no contradiction to current observations that subtype does not influence therapy response [19]

Summary

Introduction

In Tanzania, the follow-up on antiretroviral therapy (ART) response is based on clinical outcomes. We investigated virological response and ARV resistance mutations in relation to clinical response in ARV-treated patients. Sixty-one (86%) and 64 (81%) of clinical responders and non-responders, respectively, had undetectable viral loads. Seventeen (71%) and 19 (79%) patients had NRTI and NNRTI resistance mutations, respectively, which were related to the ART in use, with no difference between clinical responders and nonresponders. The prevalence of ARV resistance mutations was high in viraemic patients and was related to the ARV prescribed. Since 2003, there has been rapid scale-up of antiretroviral treatment (ART) for HIV infection in resource-limited countries, which has been identified as an international health care priority [3]. The public health approach to scaling up ART in resource-limited settings involves the use of standardized and simplified treatment regimens that are consistent with international standards and appropriate to local circumstances [4]. The emergence of some HIV drug resistance (HIVDR) is inevitable in populations taking ART, even if appropriate ART regimens are provided and optimal adherence to therapy is supported [3]

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Results

Conclusion