title: Early virological failure and HIV drug resistance in Ugandan adults co-infected with tuberculosis.
abstract: OBJECTIVE
  This cross-sectional study took place in the integrated tuberculosis (TB) clinic of a large outpatient clinic for HIV-infected patients in Kampala, Uganda. The purpose of this study was to describe the proportion of TB/HIV co-infected adults with virological failure, type and frequency of HIV drug resistance-associated mutations, and the proportion of patients with suboptimal efavirenz levels.
  
  
  METHODS
  HIV-1 plasma viral loads, CD4 cell count measurements, and efavirenz serum concentrations were done in TB/HIV co-infected adults. Genotypic resistance testing was performed in case of confirmed virological failure.
  
  
  RESULTS
  After a median time on ART of 6 months, virological failure was found in 22/152 patients (14.5%). Of 147 participants with available efavirenz serum concentration, 26 (17.6%) had at least one value below the reference range, including 20/21 (95.2%) patients with confirmed virological failure. Genotypic resistance testing was available for 16/22 (72.7%) patients, of which 15 (93.8%) had at least one major mutation, most commonly M184V (81.2%) and K103NS (68.8%).
  
  
  CONCLUSIONS
  We found a high proportion of TB/HIV co-infected patients with virological failure, the majority of which had developed relevant resistance-mutations after a median time on anti-retroviral treatment (ART) of 6 months. Virological monitoring should be prioritized in TB/HIV co-infected patients in resource-limited settings.
authors.affiliation: Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda. amrei.vonbraun@usz.ch.|Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland. amrei.vonbraun@usz.ch.
authors.forename: Amrei
authors.initials: A
authors.lastname: von Braun
authors.affiliation: Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.
authors.forename: Christine
authors.initials: C
authors.lastname: Sekaggya-Wiltshire
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
authors.forename: Alexandra U
authors.initials: AU
authors.lastname: Scherrer
authors.affiliation: Uganda Research Unit on AIDS, Medical Research Council, Ugandan Virus Research Institute, Entebbe, Uganda.
authors.forename: Brian
authors.initials: B
authors.lastname: Magambo
authors.affiliation: Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.
authors.forename: Andrew
authors.initials: A
authors.lastname: Kambugu
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
authors.forename: Jan
authors.initials: J
authors.lastname: Fehr
authors.affiliation: Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.
authors.forename: Barbara
authors.initials: B
authors.lastname: Castelnuovo
mesh_terms: D000328:Adult; D000480:Alkynes; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D000995:Antitubercular Agents / Q000627:therapeutic use; D048588:Benzoxazines / Q000097:blood / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D060085:Coinfection / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D003521:Cyclopropanes; D024882:Drug Resistance, Viral; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000382:microbiology*; D015497:HIV-1 / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D008297:Male; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy / Q000821:virology*; D014454:Uganda; D019562:Viral Load / Q000187:drug effects
chemical_list: D000480:Alkynes; D019380:Anti-HIV Agents; D000995:Antitubercular Agents; D048588:Benzoxazines; D003521:Cyclopropanes; C098320:efavirenz
keywords: Efavirenz; HIV drug resistance; Treatment monitoring; Tuberculosis/HIV co-infection; Virological failure