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JAIDS Journal of Acquired Immune Deficiency Syndromes:
doi: 10.1097/01.qai.0000429283.53243.95
Abstracts: PDF Only

A105 Virologic versus immunologic monitoring and the rate of accumulated genotypic resistance to first-line antiretroviral drugs in Uganda

Reynolds, Steven J.; Sendigire, Hakim; Newell, Kevin; Castelnuovo, Barbara; Nankya, Immaculate; Kamya, Moses; Quinn, Thomas C.; Manabe, Yukari C; Kambugu, Andrew

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Abstract

Background: Viral load monitoring (VLM) to identify individuals failing antiretroviral therapy (ART) is not widely available in resource-limited settings. We compared the genotypic resistance patterns between clients with VLM versus immunological monitoring (IM).

Methods: Between 2004-2008, 559 ART naive clients were enrolled in a prospective cohort, initiated on ART, and monitored with viral load (VL) and CD4+ cell counts every 6 months (VLM group). From February 2008 through June 2009, 998 clients on ART for 36-40 months (corresponding to the follow-up time of the VLM group) at the same clinic and monitored with CD4+ cell counts every 6 months were recruited into a cross sectional study (IM group). Samples from VLM clients at 12, 24 and 36 months and IM clients with VL>2000 copies/ml (36-40 months) underwent genotypic drug resistance testing.

Results: Baseline characteristics were similar. Virologic failure (VL> 400 copies/ml) at 12, 24 and 36 months in the VLM group were 12%, 6% and 8% respectively, and in the IM group 10% at 36-40 months. Samples from 39 VLM and 70 IM clients were genotyped. 23/39 (59%) clients in the VLM group (at 12, 24 or 36 months) compared to 63/70 (90%) in the IM group, (P<0.0001) had at least 1 non-nucleoside reverse transcriptase mutation. 19/39 (49%) of VLM clients had an M184V mutation compared to 61/70 (87%) in the IM group (P<0.0001). Only 2/39 (5%) of VLM clients developed thymidine analogue mutations compared to 34/70 (49%) of IM clients (P<0.0001).

Conclusions: Routine VL monitoring reduced the rate of accumulated genotypic resistance to commonly used ART in Uganda.

(C) 2013 Lippincott Williams & Wilkins, Inc.

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