title: Antiretroviral treatment failure predicts mortality in rural Tanzania.
abstract: Virological monitoring of HIV-infected patients on antiretroviral treatment (ART) is rarely available in resource-limited settings and many patients experience unrecognized virological failure. We studied the long-term consequences of virological failure in rural Tanzania. Previously, virological efficacy was measured in a cohort treated with ART. In the present study, patients with virological failure (VF; HIV-RNA >400 copies/ml) were followed up and compared to those with virological response (VR; HIV-RNA <400 copies/ml) with regard to mortality, CD4 change and subsequent virological outcome. Fifty-six patients with VF had a median CD4 count of 358 cells/µl (interquartile range [IQR] 223-635) and a median HIV-RNA of 13,573 copies/ml (IQR 2326-129,736). Median CD4 count for those with VR was 499 cells/µl (IQR 290-636). During a median follow-up time of 39 months (IQR 18-42), 8 of 56 patients (14.3%) with VF died, compared to 1 of 63 patients (1.6%) with VR (p = 0.009). All registered deaths were HIV-related. Of 55 patients with subsequent HIV-RNA measurements, only 12 of 30 (40%) patients with VF achieved virological suppression, compared to 20 of 25 (80%) patients with VR (p = 0.003). Virological failure predicted death and subsequent virological failure in patients on ART in a resource-limited setting.
authors.affiliation: Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Pernille S
authors.initials: PS
authors.lastname: Pettersen
authors.affiliation: Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Ida K
authors.initials: IK
authors.lastname: Brox
authors.affiliation: HIV Care and Treatment Center, Haydom Lutheran Hospital, Mbulu, Tanzania.
authors.forename: Ezra
authors.initials: E
authors.lastname: Naman
authors.affiliation: University Hospital of Northern Norway, Tromsø, Norway.
authors.forename: Johan N
authors.initials: JN
authors.lastname: Bruun
authors.affiliation: Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Dyrhol-Riise
authors.affiliation: Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway.
authors.forename: Marius
authors.initials: M
authors.lastname: Trøseid
authors.affiliation: Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway Vestre Viken HF, Drammen Hospital, Drammen, Norway johannessen.asgeir@gmail.com.
authors.forename: Asgeir
authors.initials: A
authors.lastname: Johannessen
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D024882:Drug Resistance, Viral / Q000235:genetics; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality / Q000821:virology; D015497:HIV-1 / Q000187:drug effects / Q000235:genetics; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012424:Rural Population; D013636:Tanzania / Q000453:epidemiology; D017211:Treatment Failure; D019562:Viral Load; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: AIDS; ART; CD4; HIV; antiretroviral therapy; long-term outcome; mortality; resource-limited settings; treatment; treatment failure; viral load