Abstract
Treatment outcomes of HIV patients receiving antiretroviral therapy (ART) in Rwanda are scarcely documented. HIV viral load (VL) and HIV drug-resistance (HIVDR) outcomes at month 12 were determined in a prospective cohort study of antiretroviral–naïve HIV patients initiating first-line therapy in Kigali. Treatment response was monitored clinically and by regular CD4 counts and targeted HIV viral load (VL) to confirm drug failure. VL measurements and HIVDR genotyping were performed retrospectively on baseline and month 12 samples. One hundred and fifty-eight participants who completed their month 12 follow-up visit had VL data available at month 12. Most of them (88%) were virologically suppressed (VL≤1000 copies/mL) but 18 had virological failure (11%), which is in the range of WHO-suggested targets for HIVDR prevention. If only CD4 criteria had been used to classify treatment response, 26% of the participants would have been misclassified as treatment failure. Pre-therapy HIVDR was documented in 4 of 109 participants (3.6%) with an HIVDR genotyping results at baseline. Eight of 12 participants (66.7%) with virological failure and HIVDR genotyping results at month 12 were found to harbor mutation(s), mostly NNRTI resistance mutations, whereas 4 patients had no HIVDR mutations. Almost half (44%) of the participants initiated ART at CD4 count ≤200cell/µl and severe CD4 depletion at baseline (<50 cells/µl) was associated with virological treatment failure (p = 0.008).Although the findings may not be generalizable to all HIV patients in Rwanda, our data suggest that first-line ART regimen changes are currently not warranted. However, the accumulation of acquired HIVDR mutations in some participants underscores the need to reinforce HIVDR prevention strategies, such as increasing the availability and appropriate use of VL testing to monitor ART response, ensuring high quality adherence counseling, and promoting earlier identification of HIV patients and enrollment into HIV care and treatment programs.
Highlights
Improved access to combined antiretroviral therapy (ART) has significantly reduced HIV-related morbidity and mortality worldwide [1]
HIV treatment and care programs in subSaharan Africa have implemented a public health approach [2] with good access to a limited number of first and second-line ART regimens and CD4 count monitoring, but little attention paid to HIV viral load monitoring and the detection of HIV drug resistance (HIVDR)
Transmitted HIVDR increases the risk of virological therapy failure [13] and compromises the efficacy of first-line ART regimens
Summary
Improved access to combined antiretroviral therapy (ART) has significantly reduced HIV-related morbidity and mortality worldwide [1]. HIV treatment and care programs in subSaharan Africa have implemented a public health approach [2] with good access to a limited number of first and second-line ART regimens and CD4 count monitoring, but little attention paid to HIV viral load monitoring and the detection of HIV drug resistance (HIVDR). Transmitted HIVDR increases the risk of virological therapy failure [13] and compromises the efficacy of first-line ART regimens. This is important in a context of limited treatment options
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