Amrei von Braun1,2, Christine Sekaggya-Wiltshire1, Nadine Bachmann2,3, Deogratius Ssemwanga4, Alexandra U Scherrer2,3, Maria Nanyonjo4, Anne Kapaata4, Pontiano Kaleebu4, Huldrych F Günthard2,3, Barbara Castelnuovo1, Jan Fehr2,5, Andrew Kambugu1. 1. Research Department, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda. 2. Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland. 3. Institute of Medical Virology, University of Zurich, Zurich, Switzerland. 4. Uganda Research Unit, Medical Research Council/Uganda Virus Research Institute (MRC/UVRI), London School of Hygiene and Tropical Medicine, Entebbe, Uganda. 5. Department of Public Health at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
Abstract
BACKGROUND: Little is known about prevalence of drug resistance among HIV-infected Ugandans, a setting with over 15 years of public sector access to antiretroviral therapy (ART) and where virological monitoring was only recently introduced. SETTING: This study was conducted in the adults' out-patient clinic of the Infectious Diseases Institute, Kampala, Uganda. METHODS: HIV genotyping was performed in ART-naive patients and in treatment-experienced patients on ART for ≥6 months with virological failure (≥1000 copies/mL). RESULTS: A total of 152 ART-naive and 2430 ART-experienced patients were included. Transmitted drug resistance was detected in 9 (5.9%) patients. After a median time on ART of 4.7 years [interquartile range: 2.5-8.7], 190 patients (7.8%) had virological failure with a median viral load of 4.4 log10 copies per milliliter (interquartile range: 3.9-4.9). In addition, 146 patients had a viral load between 51 and 999 copies per milliliter. Most patients with virological failure (142, 74.7%) were on first-line ART. For 163 (85.8%) ART-experienced patients, genotype results were available. Relevant drug-resistance mutations were observed in 135 (82.8%), of which 103 (63.2%) had resistance to 2 drug classes, and 11 (6.7%) had resistance to all drug classes available in Uganda. CONCLUSION: The prevalence of transmitted drug resistance was lower than recently reported by the WHO. With 92% of all patients virologically suppressed on ART, the prevalence of virological failure was low when a cutoff of 1000 copies per milliliter is applied, and is in line with the third of the 90-90-90 UNAIDS targets. However, most failing patients had developed multiclass drug resistance.
BACKGROUND: Little is known about prevalence of drug resistance among HIV-infected Ugandans, a setting with over 15 years of public sector access to antiretroviral therapy (ART) and where virological monitoring was only recently introduced. SETTING: This study was conducted in the adults' out-patient clinic of the Infectious Diseases Institute, Kampala, Uganda. METHODS: HIV genotyping was performed in ART-naive patients and in treatment-experienced patients on ART for ≥6 months with virological failure (≥1000 copies/mL). RESULTS: A total of 152 ART-naive and 2430 ART-experienced patients were included. Transmitted drug resistance was detected in 9 (5.9%) patients. After a median time on ART of 4.7 years [interquartile range: 2.5-8.7], 190 patients (7.8%) had virological failure with a median viral load of 4.4 log10 copies per milliliter (interquartile range: 3.9-4.9). In addition, 146 patients had a viral load between 51 and 999 copies per milliliter. Most patients with virological failure (142, 74.7%) were on first-line ART. For 163 (85.8%) ART-experienced patients, genotype results were available. Relevant drug-resistance mutations were observed in 135 (82.8%), of which 103 (63.2%) had resistance to 2 drug classes, and 11 (6.7%) had resistance to all drug classes available in Uganda. CONCLUSION: The prevalence of transmitted drug resistance was lower than recently reported by the WHO. With 92% of all patients virologically suppressed on ART, the prevalence of virological failure was low when a cutoff of 1000 copies per milliliter is applied, and is in line with the third of the 90-90-90 UNAIDS targets. However, most failing patients had developed multiclass drug resistance.
Authors: Allan Buzibye; Joseph Musaazi; Amrei von Braun; Sarah Nanzigu; Christine Sekaggya-Wiltshire; Andrew Kambugu; Jan Fehr; Mohammed Lamorde; Ursula Gutteck; Daniel Muller; Stefanie Sowinski; Steven J Reynolds; Barbara Castelnuovo Journal: AIDS Res Ther Date: 2019-12-06 Impact factor: 2.250
Authors: Gertrude Namale; Onesmus Kamacooko; Daniel Bagiire; Yunia Mayanja; Andrew Abaasa; William Kilembe; Matt Price; Deogratius Ssemwanga; Sandra Lunkuse; Maria Nanyonjo; William Ssenyonga; Philippe Mayaud; Rob Newton; Pontiano Kaleebu; Janet Seeley Journal: Sex Transm Infect Date: 2019-07-02 Impact factor: 3.519
Authors: Cheng Bo Li; Ying Zhou; Yu Wang; Sheng Liu; Wen Wang; Xu Lu; Cui Ming Sun; Pei Liu; Qing-Hai Hu; Ying Wen Journal: Front Public Health Date: 2021-11-30