Abstract
This study was funded by the East Africa Public health Laboratory Network Project (EAPHLNP)/Burundi. Abstract Virological failure in management of HIV-1 infection has been reported to be between 11 to 24% after 12 months of treatment. Out of these, acquired or transmitted drug resistance mutations have been reported at 71% to 90% in Sub-Sahara Africa. In this cross-sectional study we aimed to determine virological failure and drug resistance mutations in HIV-1 infected patients on ART attending Kayanza district hospital, Burundi. Patients were recruited using a purposive sampling technique. After informed consent, 4mL of venous blood was collected from each patient. The blood was separated into plasma and cells for various laboratory assays. Plasma viral loads were quantified using the Abbott m2000rt system. Polymerase chain reaction using gene specific primers was done after extraction of nucleic acids from plasma with >1000 copies/ mL, followed by sequencing of all amplified samples. Drug resistance was determined using the IAS and Stanford University database, with phylogenetic analyses done using the neighbor joining method.Two hundred patients were recruited; 13% of the respondents had virological failure associated with multiple sex partners (adjusted odds ratio (aOR, 0.154 , p =0.016) and irregularity in taking medications (aOR: 0.4 , p=0.014). Fifteen samples were successfully sequenced; 80% (12/15) were HIV-1 subtype C, 7% (1/15) subtype A, and 13% (2/15) were HIV-1 subtype A1. Of these, 87.5% had at least one mutation (NRTI or NNRTI), while 12.5 % did not carry any Drug Resistance Mutations. The most common drug resistance mutations were M183V, T215V M41L, E44D, L74I, L210W and K65R, K103N, Y188H. The prevalence of virological failure was established at 13%.Our findings showed possible gaps in the last 90% of the 90-90-90 WHO target by 2020. The results highlight the need for intense viral load and resistance testing for patients to improve overall treatment outcome. Some strategies are needed to improve adherence counselling and drug resistance mutation testing should be implemented to monitor HIV-1 patients on ART in Burundi. Keywords: HIV-1, antiretroviral therapy, Virological failure, DRMs, Burundi. DOI : 10.7176/JBAH/9-10-05 Publication date :May 31 st 2019
Highlights
The increasing use of ART has increased the lifespan of HIV infected persons and the lifespan of such a population has moved closer to HIV non infected populations (Nsanzimana et al, 2015)
According to the Spectrum estimates (Version 2015), the number of people living with HIV (PLHIV) in Burundi was 81,965(adults and children), amounting to an estimated ART coverage of 51% (56% among adult, and 17% among children) (Summary, 2016).To date, the use of CD4 count and Viral load testing in Burundi have been implemented as monitoring of treatment failure but little is known about the prevalence of virological failure and patterns of drug resistance in HIV-infected patients in Burundi
Stratification by religion, 73.5% (n=147) were christian catholics while 52% (n=104) were married On the level of education, 82.5% (n=165) reported completing primary school while farming as occupation was reported by 65% (n=131) with 94% (n=188) reporting to earn below BIF 200.The study realized that 12.5% (25) of the patients were on tuberculosis (TB) medications while 57% (114) had been on antiretroviral (ARV) therapy for between six to ten years
Summary
The increasing use of ART has increased the lifespan of HIV infected persons and the lifespan of such a population has moved closer to HIV non infected populations (Nsanzimana et al, 2015). Despite of these successes, Virological failure have been reported in many studies one year after initiation of HAART in the patients on ART despite effective combination therapy. Virological failure have been reported in many studies one year after initiation of HAART in the patients on ART despite effective combination therapy This will inevitably be accompanied by the emergence and transmission of drug resistance viruses (Hamers et al, 2013). Our study was aimed at determining the prevalence of virological failure and describing drug resistance mutations in HIV-1 infected patients on ART over 12 months of first line therapy, attending Kayanza district hospital, Burundi
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