title: Virological failure and drug resistance during first line anti-retroviral treatment in Indonesia.
abstract: The virological response and development of drug resistance during first-line anti-retroviral treatment (ART) were studied in Indonesia where the majority of patients infected with HIV have a history of injecting drug use, which is often linked with lower treatment adherence and development of drug-resistance. As many as 575 patients starting ART between September 2007 and March 2010 in Hasan Sadikin Hospital Bandung were followed prospectively. Clinical and laboratory monitoring was performed every 6 months. Plasma samples with HIV-RNA ≥ 400 copies/ml were examined for drug resistance mutations. Most patients were male (72.3%), 59.7% had a history of injecting drug use, and the median CD4+ cells count before start of ART was 35 cells/mm(3) (IQR 10-104). From 438 HIV patients with HIV-RNA measurements, 40 (9.1%) subjects had HIV-RNA ≥ 400 copies/ml after 24 weeks (median follow-up 16 (IQR 8-25) months). Of these failing patients 16 (47%) subjects had drug resistance mutations, predominantly M184V (35.3%), Y181C (23.5%), K103N (11.7%), and TAMs (11.7%). A history of treatment discontinuation ≥ 1 month, reported by 5.3% (23) of patients, was strongly associated with virological failure (adjusted OR 12.64, 95% CI 4.51-35.41); and a history of injecting drug use was not (OR 0.75, 95% CI 0.38-1.46). This is the largest and most systematic evaluation of virological response to first line ART in Indonesia. Patients in this cohort responded well to first line ART, with low rates of virological failure and drug resistance. A history of injecting drug use should not be a reason to withhold ART in this setting.
authors.affiliation: Department of Virology, Erasmus Medical Centre, Erasmus University, Rotterdam, The Netherlands. a.fibriani@erasmusmc.nl
authors.forename: Azzania
authors.initials: A
authors.lastname: Fibriani
authors.forename: Rudi
authors.initials: R
authors.lastname: Wisaksana
authors.forename: Agnes
authors.initials: A
authors.lastname: Indrati
authors.forename: Yovita
authors.initials: Y
authors.lastname: Hartantri
authors.forename: David
authors.initials: D
authors.lastname: van de Vijver
authors.forename: Martin
authors.initials: M
authors.lastname: Schutten
authors.forename: Bachti
authors.initials: B
authors.lastname: Alisjahbana
authors.forename: Primal
authors.initials: P
authors.lastname: Sudjana
authors.forename: Charles A B
authors.initials: CA
authors.lastname: Boucher
authors.forename: Reinout
authors.initials: R
authors.lastname: van Crevel
authors.forename: Andre
authors.initials: A
authors.lastname: van der Ven
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D024882:Drug Resistance, Viral; D005260:Female; D005500:Follow-Up Studies; D006678:HIV / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology*; D006801:Humans; D007214:Indonesia; D008297:Male; D020125:Mutation, Missense; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood / Q000235:genetics; D017211:Treatment Failure; D019562:Viral Load; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents; D012367:RNA, Viral