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. 2012;7(12):e47391.
doi: 10.1371/journal.pone.0047391. Epub 2012 Dec 6.

Monitoring HIV viral load in resource limited settings: still a matter of debate?

Mireia Arnedo  1 , Elena Alonso, Nell Eisenberg, Laura Ibáñez, Cecilia Ferreyra, Angels Jaén, Laurence Flevaud, Samuel Khamadi, Paul Roddy, Jose Maria Gatell, David Dalmau; Busia O R Study Group
Affiliations

Monitoring HIV viral load in resource limited settings: still a matter of debate?

Mireia Arnedo et al. PLoS One. 2012.

Abstract

Introduction: Consequences of lack of viral monitoring in predicting the effects of development of HIV drug resistance mutations during HAART in resource-limited settings (RLS) is still a matter of debate.

Design: To assess, among HIV+ patients receiving their first-line HAART, prevalence of virological failure and genotypic resistance mutations pattern in a Médécins Sans Frontières/Ministry of Health programme in Busia District (Kenya).

Methods: Patients with HAART treatment for ≥12 months were eligible for the study and those with HIV-RNA ≥5000 copies/ml underwent genotypic study. Total HIV-1 RNA from Dried Blood Spots was extracted using Nuclisens method.

Results: 926 patients were included. Among 274 (29.6%) patients with detectable viral load, 55 (5.9%) experienced treatment failure (viral load >5.000 copies/ml); 61.8% were female and 10 (18.2%) had clinical failure. Median CD4 cell count was 116 cell/mm3 (IQR: 54-189). Median HIV-RNA was 32,000 copies/ml (IQR: 11000-68000). Eighteen out of 55 (33%) samples could be sequenced on PR and RT genes, with resistance associated mutations (RAMs) in 15 out of 18 samples (83%). Among patients carrying RAMs, 12/15 (81%) harboured RAMs associated to thymidine analogues (TAMs). All of them (100%) showed M184V resistance associated mutation to lamivudine as well as NNRTI's RAMS.

Conclusions: Virological failure rate in resource-limited settings are similar to those observed in developed countries. Resistance mutation patterns were concordant with HAART received by failing patients. Long term detectable viral load confers greater probability of developing resistance and as a consequence, making difficult to find out a cost-effective subsequent treatment regimen.

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Conflict of interest statement

Competing Interests: D Dalmau and JM Gatell have been a consultant on advisory boards, have participated in speakers' bureaus, have received research grants or have conducted clinical trials with Roche, Boehringer Ingelheim, Abbott, BMS, GSK, Gilead, Janssen, Merck and Pfizer. M. Arnedo, E. Alonso, N. Eisenberg, L. Ibáñez, C. Ferreyra, A. Jaén, L. Flevaud, S. Khamadi, P. Roddy, J. Mashala, A. Alvarez and E. Velilla report no conflicts of interest relevant to this article. No other potential conflict of interest relevant to this article was reported. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Patient's disposition.
Figure 2
Figure 2. NNRTI's resistance mutations prevalence.
Figure 3
Figure 3. NRTI's resistance mutations prevalence.
See this image and copyright information in PMC

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