ArticleJournal of AIDS & clinical research2011
Drug resistance patterns and virus re-suppression among HIV-1 subtype C infected patients receiving non-nucleoside reverse transcriptase inhibitors in South Africa.
Article in Journal of AIDS & clinical research, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
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Who cites it
17 citing papers in PubMed.
- Resistance Testing for Management of HIV Virologic Failure in Sub-Saharan Africa : An Unblinded Randomized Controlled Trial.Annals of internal medicine · 2021Trial
- Challenges with tracing patients on antiretroviral therapy who are late for clinic appointments in rural South Africa and recommendations for future practice.Global health action · 2020Article
- HIV-1 re-suppression on a first-line regimen despite the presence of phenotypic drug resistance.PloS one · 2020Article
- Successes and challenges in optimizing the viral load cascade to improve antiretroviral therapy adherence and rationalize second-line switches in Swaziland.Journal of the International AIDS Society · 2018Article
- Accumulated pre-switch resistance to more recently introduced one-pill-once-a-day antiretroviral regimens impacts HIV-1 virologic outcome.Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology · 2018Article
- High level of HIV-1 drug resistance mutations in patients with unsuppressed viral loads in rural northern South Africa.AIDS research and therapy · 2017Article
- The REVAMP trial to evaluate HIV resistance testing in sub-Saharan Africa: a case study in clinical trial design in resource limited settings to optimize effectiveness and cost effectiveness estimates.HIV clinical trials · 2017Review
- The Effect of Switching to Second-Line Antiretroviral Therapy on the Risk of Opportunistic Infections Among Patients Infected With Human Immunodeficiency Virus in Northern Tanzania.Open forum infectious diseases · 2016Article
- Marginal Structural Models to Assess Delays in Second-Line HIV Treatment Initiation in South Africa.PloS one · 2016Observational
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- Durable HIV RNA resuppression after virologic failure while remaining on a first-line regimen: a cohort study.Tropical medicine & international health : TM & IH · 2014Article
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- Effective coverage for antiretroviral therapy in a Ugandan district with a decentralized model of care.PloS one · 2013Article
- Long-term efficacy of first line antiretroviral therapy in Indian HIV-1 infected patients: a longitudinal cohort study.PloS one · 2013Article
- Second-line antiretroviral therapy: long-term outcomes in South Africa.Journal of acquired immune deficiency syndromes (1999) · 2012Article
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Authors and funding
10 authors.
Funding
Abstract
backgroundEmergence of HIV-1 drug resistance is at times an inevitable and anticipated consequence of antiretroviral therapy (ART) failure. We examined drug resistance patterns and virus re-suppression among subtype C-infected South African patients receiving first-line ART.
methodsTreatment records of 431 patients on NNRTI-containing regimens for a median of 45 months were analyzed. Patients with viral load (VL) >400 copies/mL were followed and drug resistance mutations (DRM) were re-assessed. Associations between clinical/demographic measures and drug resistance/virologic outcomes were examined using Fisher exact and ordinal and logistic regression.
resultsTen percent of patients (43/431) were viremic at enrollment (98% previously suppressed); sequences were obtained from 38/43. Of those, 82% had 1-7 DRM. In bivariate analysis remote exposure to single-dose nevirapine or prior ART; higher CD4 counts; lower VL; and >6 months of virologic failure were significantly associated with number of DRM. Of 25 viremic patients followed for a median of 8 months on a continued first-line regimen, 12 (48%) re-suppressed, six with K103N and three with M184V. Thirteen (52%) had continued virologic failure which was significantly associated with detectable VL>6 months prior to enrollment and number of DRM.
conclusionAmong these HIV-1 subtype C-infected patients, DRM numbers and patterns were associated with prior exposure to sub-optimal ART, adherence and duration of virologic failure. Viral re-suppression in the presence of K103N and M184V challenges assumptions about drug resistance. In resource-limited settings, where genotyping and alternative drug options are unavailable, continuing first-line treatment, reinforcing adherence and regular virologic monitoring may be effective even after virologic failure.
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