Abstract
BackgroundAn observational study was conducted in Maputo, Mozambique, to investigate trends in prevalence of HIV drug resistance (HIVDR) in antiretroviral (ART) naïve subjects initiating highly active antiretroviral treatment (HAART).Methodology/Principal FindingsTo evaluate the pattern of drug resistance mutations (DRMs) found in adults on ART failing first-line HAART [patients with detectable viral load (VL)]. Untreated subjects [Group 1 (G1; n=99)] and 274 treated subjects with variable length of exposure to ARV´s [6–12 months, Group 2 (G2;n=93); 12-24 months, Group 3 (G3;n=81); >24 months (G4;n=100)] were enrolled. Virological and immunological failure (VF and IF) were measured based on viral load (VL) and T lymphocyte CD4+ cells (TCD4+) count and genotypic resistance was also performed. Major subtype found was C (untreated: n=66, 97,06%; treated: n=36, 91.7%). Maximum virological suppression was observed in G3, and significant differences intragroup were observed between VF and IF in G4 (p=0.022). Intergroup differences were observed between G3 and G4 for VF (p=0.023) and IF between G2 and G4 (p=0.0018). Viral suppression (<50 copies/ml) ranged from 84.9% to 90.1%, and concordant VL and DRM ranged from 25% to 57%. WHO cut-off for determining VF as given by 2010 guidelines (>5000 copies/ml) identified 50% of subjects carrying DRM compared to 100% when lower VL cut-off was used (<50 copies/ml). Length of exposure to ARVs was directly proportional to the complexity of DRM patterns. In Mozambique, VL suppression was achieved in 76% of individuals after 24 months on HAART. This is in agreement with WHO target for HIVDR prevention target (70%).ConclusionsWe demonstrated that the best way to determine therapeutic failure is VL compared to CD4 counts. The rationalized use of VL testing is needed to ensure timely detection of treatment failures preventing the occurrence of TDR and new infections.
Highlights
Mozambique, a sub-Saharan country with HIV prevalence of 11.5% [1], provides highly active antiretroviral therapy (HAART) based on a public health approach [2,3]
We demonstrated that the best way to determine therapeutic failure is viral load (VL) compared to CD4 counts
Treated subjects group was further subdivided into three different subgroups according to length of exposure to ARVs [6–12 months, Group 2 (G2; n = 93); 12–24 months, Group 3 (G3; n = 81); 24< months (G4; n = 100)]
Summary
Mozambique, a sub-Saharan country with HIV prevalence of 11.5% [1], provides highly active antiretroviral therapy (HAART) based on a public health approach [2,3]. The antiretroviral (ARV) program was introduced in 2003 and was initially mainly provided at the capital city, Maputo. Rapid scale-up accompanied by decentralization and integration of HIV care within primary care services, resulted in 308.578 people being put on HAART by December 2012 [4]. Treatment options are based on WHO guidelines for treating HIV infected people in low income countries. An observational study was conducted in Maputo, Mozambique, to investigate trends in prevalence of HIV drug resistance (HIVDR) in antiretroviral (ART) naïve subjects initiating highly active antiretroviral treatment (HAART)
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