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Antiretroviral Treatment Interruptions Induced by the Kenyan Postelection Crisis Are Associated With Virological Failure

Mann, Marita MPH*; Diero, Lameck MD†,‡; Kemboi, Emmanuel BSc†,‡; Mambo, Fidelis MSc†,‡; Rono, Mary BSc†,‡; Injera, Wilfred PhD†,‡; Delong, Allison MSc§; Schreier, Leeann MSc; Kaloustian, Kara W. MD; Sidle, John MD**; Buziba, Nathan MD†,‡; Kantor, Rami MD

JAIDS Journal of Acquired Immune Deficiency Syndromes: October 1st, 2013 - Volume 64 - Issue 2 - p 220–224
doi: 10.1097/QAI.0b013e31829ec485
Brief Report: Epidemiology and Prevention

Background: Antiretroviral treatment interruptions (TIs) cause suboptimal clinical outcomes. Data on TIs during social disruption are limited.

Methods: We determined effects of unplanned TIs after the 2007–2008 Kenyan postelection violence on virological failure, comparing viral load (VL) outcomes in HIV-infected adults with and without conflict-induced TI.

Results: Two hundred and one patients were enrolled, median 2.2 years after conflict and 4.3 years on treatment. Eighty-eight patients experienced conflict-related TIs and 113 received continuous treatment. After adjusting for preconflict CD4, patients with TIs were more likely to have detectable VL, VL >5,000 and VL >10,000.

Conclusions: Unplanned conflict-related TIs are associated with increased likelihood of virological failure.

*Department of Public Health, Brown University, Providence, RI;

Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya;

Academic Model Providing Access To Health Care (AMPATH), Eldoret, Kenya;

§Center for Statistical Sciences, Brown University, Providence, RI;

Department of Medicine, Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, RI;

Department of Medicine, Division of Infectious Diseases, Indiana University, Indianapolis, IN; and

**Department of Medicine, Division of General Internal Medicine, Indiana University, Indianapolis, IN.

Correspondence to: Rami Kantor, MD, The Miriam Hospital, RISE 154, 164 Summit Avenue, Providence, RI 02906 (e-mail:

M.M. and L.D. have contributed equally.

Supported by the National Institutes of Health (Grant numbers R25-TW008102, RO1-AI66922, P30AI042853, and 5U01AI069911).

This research was based in part upon work conducted using the Rhode Island Genomics and Sequencing Center, which is supported in part by the National Science Foundation (MRI Grant No. DBI-0215393 and EPSCoR Grant Nos. 0554548 & EPS-1004057), the US Department of Agriculture (Grant Nos. 2002-34438-12688 and 2003-34438-13111), and the University of Rhode Island.

Presented at the Conference on Retroviruses and Opportunistic Infections, March 5–8, 2012, Seattle, WA.

The authors have no conflicts of interest to disclose.

Received January 07, 2013

Accepted May 21, 2013

© 2013 by Lippincott Williams & Wilkins