ArticleBMC infectious diseases2009
Virological efficacy and emergence of drug resistance in adults on antiretroviral treatment in rural Tanzania.
Article in BMC infectious diseases, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 2 of them syntheses that pooled it.
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Who cites it
22 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Pooled it
- Pooled it
- What Time is it? Adherence to Antiretroviral Therapy in Ethiopia.AIDS and behavior · 2016Trial
- Epidemiologic and viral predictors of antiretroviral drug resistance among persons living with HIV in a large treatment program in Nigeria.AIDS research and therapy · 2020Article
- Outcomes of an HIV cohort after a decade of comprehensive care at Newlands Clinic in Harare, Zimbabwe: TENART cohort.PloS one · 2017Article
- HIV virological failure and drug resistance in a cohort of Tanzanian HIV-infected adults.The Journal of antimicrobial chemotherapy · 2016Article
- Cost Effectiveness of Potential ART Adherence Monitoring Interventions in Sub-Saharan Africa.PloS one · 2016Article
- Virological outcome among HIV-1 infected patients on first-line antiretroviral treatment in semi-rural HIV clinics in Togo.AIDS research and therapy · 2015Article
- Virological efficacy and immunological recovery among Ethiopian HIV-1 infected adults and children.BMC infectious diseases · 2014Article
- Community viral load and CD4 count distribution among people living with HIV in a South African Township: implications for treatment as prevention.Journal of acquired immune deficiency syndromes (1999) · 2013Article
- Incidence and associated factors of HIV drug resistance in Chinese HIV-infected patients receiving antiretroviral treatment.PloS one · 2013Article
- Antiretroviral drug susceptibility among HIV-infected adults failing antiretroviral therapy in Rakai, Uganda.AIDS research and human retroviruses · 2012Article
- A retrospective survey of HIV drug resistance among patients 1 year after initiation of antiretroviral therapy at 4 clinics in Malawi.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2012Article
- Initial virologic response and HIV drug resistance among HIV-infected individuals initiating first-line antiretroviral therapy at 2 clinics in Chennai and Mumbai, India.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2012Article
- Low rates of nucleoside reverse transcriptase inhibitor resistance in a well-monitored cohort in South Africa on antiretroviral therapy.Antiviral therapy · 2012Article
- Reverse transcriptase drug resistance mutations in HIV-1 subtype C infected patients on ART in Karonga District, Malawi.AIDS research and therapy · 2011Article
- Antiretroviral treatment reverses HIV-associated anemia in rural Tanzania.BMC infectious diseases · 2011Article
- Improved antiretroviral treatment outcome in a rural African setting is associated with cART initiation at higher CD4 cell counts and better general health condition.BMC infectious diseases · 2011Article
- Association between medication possession ratio, virologic failure and drug resistance in HIV-1-infected adults on antiretroviral therapy in Côte d'Ivoire.Journal of acquired immune deficiency syndromes (1999) · 2011Article
- Drug resistance is widespread among children who receive long-term antiretroviral treatment at a rural Tanzanian hospital.The Journal of antimicrobial chemotherapy · 2010Article
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8 authors.
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Abstract
backgroundVirological response to antiretroviral treatment (ART) in rural Africa is poorly described. We examined virological efficacy and emergence of drug resistance in adults receiving first-line ART for up to 4 years in rural Tanzania.
methodsHaydom Lutheran Hospital has provided ART to HIV-infected patients since October 2003. A combination of stavudine or zidovudine with lamivudine and either nevirapine or efavirenz is the standard first-line regimen. Nested in a longitudinal cohort study of patients consecutively starting ART, we carried out a cross-sectional virological efficacy survey between November 2007 and June 2008. HIV viral load was measured in all adults who had completed at least 6 months first-line ART, and genotypic resistance was determined in patients with viral load >1000 copies/mL.
resultsVirological response was measured in 212 patients, of whom 158 (74.5%) were women, and median age was 35 years (interquartile range [IQR] 29-43). Median follow-up time was 22.3 months (IQR 14.0-29.9). Virological suppression, defined as <400 copies/mL, was observed in 187 patients (88.2%). Overall, prevalence of > or =1 clinically significant resistance mutation was 3.9, 8.4, 16.7 and 12.5% in patients receiving ART for 1, 2, 3 and 4 years, respectively. Among those successfully genotyped, the most frequent mutations were M184I/V (64%), conferring resistance to lamivudine, and K103N (27%), Y181C (27%) and G190A (27%), conferring resistance to non-nucleoside reverse transcriptase inhibitors (NNRTIs), whereas 23% had thymidine analogue mutations (TAMs), associated with cross-resistance to all nucleoside reverse transcriptase inhibitors (NRTIs). Dual-class resistance, i.e. resistance to both NRTIs and NNRTIs, was found in 64%.
conclusionVirological suppression rates were good up to 4 years after initiating ART in a rural Tanzanian hospital. However, drug resistance increased with time, and dual-class resistance was common, raising concerns about exhaustion of future antiretroviral drug options. This study might provide a useful forecast of drug resistance and demand for second-line antiretroviral drugs in rural Africa in the coming years.
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