Título:
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Previous antiretroviral drug use compromises standard
first-line HIV therapy and is mediated through drug-resistance
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Autor/a:
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Inzaule, Seth C.; Kityo, Cissy M.; Siwale, Margaret; Akanmu, Alani Sulaimon; Wellington, Maureen; Jager, Marleen de; Ive, Prudence; Mandaliya, Kishor; Stevens, Wendy; Boender, T. Sonia; Ondoa, Pascale; Sigaloff, Kim C. E.; Naniche, Denise; Rinke de Wit, Tobias F.; Hamers, Raph L.
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Abstract:
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In ART programs in sub-Saharan Africa, a growing proportion of HIV-infected persons initiating first-line antiretroviral therapy (ART) have a history of prior antiretroviral drug use (PAU). We assessed the effect of PAU on the risk of pre-treatment drug resistance (PDR) and virological failure (VF) in a multicountry cohort of HIV-infected adults initiated on a standard non-nucleoside reverse transcriptase inhibitor (NNRTI)-based first-line ART. Multivariate logistic regression was used to assess the associations between PAU, PDR and VF (defined as viral load ≥400 cps/mL). Causal mediation analysis was used to assess the proportion of the effect of PAU on VF that could be eliminated by intervening on PDR. Of 2737 participants, 122 (4.5%) had a history of PAU. Participants with PAU had a 7.2-fold (95% CI 4.4–11.7) risk of carrying PDR and a 3.1-fold (95% CI 1.6–6.1) increased risk of VF, compared to antiretroviral-naïve participants. Controlling for PDR would eliminate nearly half the effect of PAU on the risk of VF. Patients with a history of PAU are at increased risk of ART failure, which is to a large extent attributable to PDR. These findings support the recent WHO recommendations for use of differentiated, non-NNRTI-based empiric first-line therapy in patients with PAU. |
Materia(s):
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-Infeccions per VIH -Àfrica subsahariana -Antiretrovirals -HIV infections -Sub-Saharan Africa -Antiretroviral agents |
Derechos:
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cc by (c) Inzaule et al., 2018
http://creativecommons.org/licenses/by/3.0/es/ |
Tipo de documento:
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Artículo Artículo - Versión publicada |
Editor:
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Nature Publishing Group
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Compartir:
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