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


CONCLUSIONS
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.
El-Khatib
Ziad
Z
Division of Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden. ziad.el-khatib@ki.se
Ekstrom
Anna Mia
AM
Ledwaba
Johanna
J
Mohapi
Lerato
L
Laher
Fatima
F
Karstaedt
Alan
A
Charalambous
Salome
S
Petzold
Max
M
Katzenstein
David
D
Morris
Lynn
L
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D024882:Drug Resistance, Viral; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology; D015497:HIV-1 / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012959:Socioeconomic Factors; D013019:South Africa / Q000453:epidemiology; D017211:Treatment Failure; D019562:Viral Load; D014766:Viremia / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology
D019380:Anti-HIV Agents
BMC Infect Dis. 2009 Jul 07;9:108
19583845
AIDS. 2006 Jan 2;20(1):140-1; author reply 141-2
16327340
HIV Med. 2010 Feb;11(2):95-103
19686436
AIDS Res Hum Retroviruses. 2004 Oct;20(10):1053-6
15585095
South Afr J HIV Med. 2020 Sep 16;21(1):1115
33101723
J Acquir Immune Defic Syndr. 2007 Dec 1;46(4):402-9
18077832
PLoS One. 2009 Sep 29;4(9):e7196
19787058
Clin Infect Dis. 2009 Jun 1;48(11):1617-23
19385733
J Acquir Immune Defic Syndr. 2010 Apr 1;53(4):480-4
19801944
J Acquir Immune Defic Syndr. 2009 Mar 1;50(3):327-30
19194308
Curr Opin HIV AIDS. 2010 Jan;5(1):70-7
20046150
N Engl J Med. 2009 Apr 30;360(18):1808-10
19403900
Clin Infect Dis. 2009 Dec 15;49(12):1928-35
19911963
Clin Chest Med. 2009 Dec;30(4):685-99, viii
19925961
Trans R Soc Trop Med Hyg. 2009 Jun;103(6):607-12
18804251
AIDS. 2002 May 3;16(7):1039-44
11953470
Clin Infect Dis. 2007 Dec 1;45(11):1492-8
17990233
AIDS Res Hum Retroviruses. 2008 Nov;24(11):1449-54
19000027
AIDS Res Treat. 2011;2011:769627
21490784
PLoS Med. 2007 Oct 16;4(10):e298
17941716
BMC Infect Dis. 2008 Jul 16;8:93
18631397
Top HIV Med. 2009 Dec;17(5):138-45
20068260
Emerg Infect Dis. 2006 Jun;12(6):1001-4
16707062
Ann Intern Med. 2007 Apr 17;146(8):564-73
17438315
Clin Infect Dis. 2008 May 15;46(10):1589-97
18419495
Antivir Ther. 2008;13 Suppl 2:101-7
18575198
J Clin Epidemiol. 2001 Dec;54 Suppl 1:S77-90
11750213
J Acquir Immune Defic Syndr. 2008 Sep 1;49(1):17-25
18667925
Bioinformatics. 2005 Oct 1;21(19):3797-800
16076886
S Afr Med J. 2009 Jun;99(6):412, 414
19739316
Indian J Med Microbiol. 2009 Jul-Sep;27(3):231-6
19584504
J Infect Dis. 2010 Mar;201(5):672-80
20102272
Antivir Ther. 2009;14(4):523-31
19578237
Stat Med. 2007 Feb 28;26(5):991-1007
16755546
J Int Assoc Physicians AIDS Care (Chic). 2008 Jul-Aug;7(4):200-7
18626120
PLoS One. 2007 Mar 14;2(3):e278
17372625
Pharmacoepidemiol Drug Saf. 2009 Nov;18(11):1007-15
19650153
JAMA. 2006 Aug 9;296(6):679-90
16896111