Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2010 Jul 17;24(11):1679-87.
doi: 10.1097/QAD.0b013e32833a097b.

Viremia and drug resistance among HIV-1 patients on antiretroviral treatment: a cross-sectional study in Soweto, South Africa

Ziad El-Khatib  1 , Anna Mia Ekstrom, Johanna Ledwaba, Lerato Mohapi, Fatima Laher, Alan Karstaedt, Salome Charalambous, Max Petzold, David Katzenstein, Lynn Morris
Affiliations
Multicenter Study

Viremia and drug resistance among HIV-1 patients on antiretroviral treatment: a cross-sectional study in Soweto, South Africa

Ziad El-Khatib et al. AIDS. .

Abstract

Background: We assessed risk factors for viremia and drug resistance among long-term recipients of antiretroviral therapy (ART) in South Africa.

Methods: In 2008, we conducted a cross-sectional study among patients receiving ART for 12 months or more. Genotypic resistance testing was performed on individuals with a viral load higher than 400 RNA copies/ml. Multiple logistic regression analysis was used to assess associations.

Results: Of 998 participants, 75% were women with a median age of 41 years. Most (64%) had been on treatment for more than 3 years. The prevalence of viremia was 14% (n = 139): 12% (102/883) on first-line [i.e. nonnucleoside reverse-transcriptase inhibitor (NNRTI)-based regimen] and 33% (37/115) on second-line (i.e. protease inhibitor (PI)-based regimen) ART. Of viremic patients, 78% had drug resistance mutations. For NRTIs, NNRTIs and PIs, the prevalence of mutations was 64, 81 and 2%, respectively, among first-line failures and 29, 54 and 6%, respectively, among second-line failures. M184V/I, K103N and V106A/M were the most common mutations. Significant risk factors associated with viremia on first-line regimen included concurrent tuberculosis treatment [odds ratio (OR) 6.4, 95% confidence interval (CI) 2.2-18.8, P < 0.01] and a recent history of poor adherence (OR 2.7, 1.3-5.6, P = 0.01). Among second-line failures, attending a public clinic (OR 4.6, 95% CI 1.8-11.3, P < 0.01) and not having a refrigerator at home (OR 6.7, 95% CI 1.2-37.5, P = 0.03) were risk factors for virological failure.

Conclusion: Risk factors for viral failure were line regimen dependent. Second-line ART recipients had a higher rate of viremia, albeit with infrequent PI drug resistance mutations. Measures to maintain effective virologic suppression should include increased adherence counseling, attention to concomitant tuberculosis treatment and heat-stable formulations of second-line ART regimens.

PubMed Disclaimer

References

    1. National department of health of South Africa . Monitoring and evaluation. Cumulative number of adults and children on comprehensive HIV and AIDS treatment plan until the end of March 2009. Johannesburg: 2009.
    1. Ford N, Mills E, Calmy A. Rationing antiretroviral therapy in Africa--treating too few, too late. N Engl J Med. 2009;360:1808–1810. - PubMed
    1. World Health Organization (WHO) Scaling up antiretroviral therapy in resource-limited settings: treatment guidelines for a public health approach: 2003 revision. WHO; Geneva, Switzerland: 2004.
    1. Maartens G, Venter F, Meintjes G, Cohen K. Southern African HIV clinicians society - Guidelines for antiretroviral therapy in adults. Johannesburg: 2008. Edited by version J. Downloaded from WHO ( http://www.who.int/entity/hiv/amds/art_guidelines_sa_hivsoc_adult.pdf) 03-Oct.-2009. - PMC - PubMed
    1. Noble R. HIV and AIDS statistics for South Africa (2006) Johannesburg: 2009.

Publication types

MeSH terms

Substances