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Importance of routine viral load monitoring : higher levels of resistance at ART failure in Uganda and Lesotho compared with Switzerland

Bachmann, Nadine and von Braun, Amrei and Labhardt, Niklaus D. and Kadelka, Claus and Günthard, Huldrych F. and Sekaggya-Wiltshire, Christine and Castelnuovo, Barbara and Kambugu, Andrew and Lejone, Thabo I. and Böni, Jürg and Yerly, Sabine and Perreau, Matthieu and Klimkait, Thomas and Kouyos, Roger D. and Fehr, Jan and Swiss HIV Cohort Study, . (2019) Importance of routine viral load monitoring : higher levels of resistance at ART failure in Uganda and Lesotho compared with Switzerland. The journal of antimicrobial chemotherapy, 74 (2). pp. 468-472.

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Official URL: https://edoc.unibas.ch/69177/

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Abstract

Emerging resistance to antiretroviral drugs may jeopardize the achievements of improved access to ART. We compared the prevalence of different resistance mutations in HIV-infected adults with virological failure in a cohort with regular routine viral load (VL) monitoring (Switzerland) and cohorts with limited access to VL testing (Uganda and Lesotho).; We considered individuals who had genotypic resistance testing (GRT) upon virological failure (≥1000 copies/mL) and were on ART consisting of at least one NNRTI and two NRTIs. From Lesotho, individuals with two subsequent VLs ≥1000 copies/mL despite enhanced adherence counselling (n = 58) were included in the analysis. From Uganda, individuals with a single VL ≥1000 copies/mL (n = 120) were included in the analysis. From the Swiss HIV Cohort Study (SHCS), a population without history of monotherapy or dual therapy with the first GRT upon virological failure (n = 61) was selected.; We found that 50.8% of individuals in the SHCS, 72.5% in Uganda and 81.0% in Lesotho harboured HIV with high-level resistance to at least two drugs from their current regimen. Stanford resistance scores were higher in Uganda compared with Switzerland for all drugs used in first-line treatment except zidovudine and tenofovir (P < 0.01) and higher in Lesotho compared with Uganda for all drugs used in first-line treatment except zidovudine (P < 0.01).; Frequent VL monitoring and possibly pretreatment GRT as done in the SHCS pays off by low levels of resistance even when treatment failure occurs. The high-level resistance patterns in Lesotho compared with Uganda could reflect a selection of strains with multiple resistance during enhanced adherence counselling.
Faculties and Departments:09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH)
09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Medicine > Clinical Research (Reither)
UniBasel Contributors:Labhardt, Niklaus
Item Type:Article, refereed
Article Subtype:Research Article
Publisher:Academic Press
ISSN:0305-7453
Note:Publication type according to Uni Basel Research Database: Journal article
Identification Number:
Last Modified:26 Feb 2019 09:35
Deposited On:26 Feb 2019 09:35

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