title: HIV virological failure and drug resistance in a cohort of Tanzanian HIV-infected adults.
abstract: There are few data on ART failure rates and drug resistance from Tanzania, where there is a wide diversity of non-B HIV subtypes. We assessed rates and predictors of virological failure in HIV-infected Tanzanians and describe drug resistance patterns in a subgroup of these patients.
  
  
  
  ART-naive, HIV-1-infected adults enrolled in a randomized controlled trial between November 2006 and 2008 and on ≥24 weeks of first-line NNRTI-containing ART were included. Population-based genotyping of HIV-1 protease and reverse transcriptase was performed on stored plasma from patients with virological failure (viral load >1000 copies/mL at ≥24 weeks of ART) and at baseline, where available.
  
  
  
  A total of 2403 patients [median (IQR) age 37 (32-43) years; 70% female] were studied. The median (IQR) baseline CD4+ T cell count was 128 (62-190) cells/μL. Predominant HIV subtypes were A, C and D (92.2%). The overall rate of virological failure was 14.9% (95% CI 13.2%-16.1%). In adjusted analyses, significant predictors of virological failure were lower CD4+ T cell count (P = 0.01) and non-adherence to ART (P < 0.01). Drug resistance mutations were present in 87/115 samples (75.7%); the most common were M184V/I (52.2%) and K103N (35%). Thymidine analogue mutations were uncommon (5.2%). The prevalence of mutations in 45 samples pre-ART was 22%.
  
  
  
  High levels of early ART failure and drug resistance were observed among Tanzanian HIV-1-infected adults enrolled in a well-monitored study. Initiating treatment early and ensuring optimal adherence are vital for the success and durability of first-line ART in these settings.
authors.affiliation: Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA c-hawkins@md.northwestern.edu.
authors.forename: Claudia
authors.initials: C
authors.lastname: Hawkins
authors.affiliation: Management and Development for Health, Dar es Salaam, Tanzania Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Nzovu
authors.initials: N
authors.lastname: Ulenga
authors.affiliation: Departments of Nutrition, Epidemiology, Biostatistics, and Global Health and Population, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Enju
authors.initials: E
authors.lastname: Liu
authors.affiliation: Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors.forename: Said
authors.initials: S
authors.lastname: Aboud
authors.affiliation: Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Mugusi
authors.affiliation: Management and Development for Health, Dar es Salaam, Tanzania.
authors.forename: Guerino
authors.initials: G
authors.lastname: Chalamilla
authors.affiliation: Management and Development for Health, Dar es Salaam, Tanzania.
authors.forename: David
authors.initials: D
authors.lastname: Sando
authors.affiliation: Management and Development for Health, Dar es Salaam, Tanzania.
authors.forename: Eric
authors.initials: E
authors.lastname: Aris
authors.affiliation: Centers for Disease Control and Prevention, Dar es Salaam, Tanzania.
authors.forename: Deborah
authors.initials: D
authors.lastname: Carpenter
authors.affiliation: Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Wafaie
authors.initials: W
authors.lastname: Fawzi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D024882:Drug Resistance, Viral; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D013636:Tanzania / Q000453:epidemiology; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents