Drug resistance in HIV patients with virological failure or slow virological response to antiretroviral therapy in Ethiopia

Daniel Yilma,Lone H Christensen,Anne M Audelin,Tsinuel Girma,Mette F Olsen,Court Pedersen,Markos Tesfaye,Abraham Aseffa,Alemseged Abdissa,Henrik Friis,Jannik Fonager,Aase B Andersen,Pernille Kaestel

doi:10.1186/1471-2334-14-181

Abstract

BackgroundThe ongoing scale-up of antiretroviral therapy (ART) in sub-Saharan Africa has prompted the interest in surveillance of transmitted and acquired HIV drug resistance. Resistance data on virological failure and mutations in HIV infected populations initiating treatment in sub-Saharan Africa is sparse.MethodsHIV viral load (VL) and resistance mutations pre-ART and after 6 months were determined in a prospective cohort study of ART-naïve HIV patients initiating first-line therapy in Jimma, Ethiopia. VL measurements were done at baseline and after 3 and 6 months. Genotypic HIV drug resistance (HIVDR) was performed on patients exhibiting virological failure (>1000 copies/mL at 6 months) or slow virological response (>5000 copies/mL at 3 months and <1000 copies/mL at 6 months).ResultsTwo hundred sixty five patients had VL data available at baseline and at 6 months. Virological failure was observed among 14 (5.3%) participants out of 265 patients. Twelve samples were genotyped and six had HIV drug resistance (HIVDR) mutations at baseline. Among virological failures, 9/11 (81.8%) harbored one or more HIVDR mutations at 6 months. The most frequent mutations were K103N and M184VI.ConclusionsOur data confirm that the currently recommended first-line ART regimen is efficient in the vast majority of individuals initiating therapy in Jimma, Ethiopia eight years after the introduction of ART. However, the documented occurrence of transmitted resistance and accumulation of acquired HIVDR mutations among failing patients justify increased vigilance by improving the availability and systematic use of VL testing to monitor ART response, and underlines the need for rapid, inexpensive tests to identify the most common drug resistance mutations.

Highlights

The ongoing scale-up of antiretroviral therapy (ART) in sub-Saharan Africa has prompted the interest in surveillance of transmitted and acquired HIV drug resistance
At ART initiation, the 265 participants retained for 6 months of follow-up did not differ significantly from the rest of participants (n =47), in terms of baseline characteristics such as age, Body mass index (BMI), viral load (VL) and World Health Organization (WHO) stage
Of the three slow responders, one (Id # 301) was resistant to all three drugs prescribed, while we found no evidence of HIV drug resistance (HIVDR) in the other two participants at 6 months (Id # 146 and 314) (Additional file 1: Table S1)

Summary

Introduction

The ongoing scale-up of antiretroviral therapy (ART) in sub-Saharan Africa has prompted the interest in surveillance of transmitted and acquired HIV drug resistance. As ART roll-out continues in resource-limited settings, the risk of potential emergence of HIV drug resistance (HIVDR) is growing. This could be due to the absence of virological monitoring in routine clinical care and the use. The World Health Organization (WHO) recommends surveillance for transmitted HIVDR among antiretroviralnaïve patients and drug resistance mutations emerging during treatment in all countries involved in the ARV access programs [8,9]. Transmitted and acquired HIV-1 drug resistance mutations have been well-described and longitudinally surveyed in high-income countries such as France [10], United States [11] and Denmark [12] there are few data on the subject in resource-limited settings

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