Drug Resistance in HIV-Positive Adults During the Initial Year of Antiretroviral Treatment at Ethiopian Health Centers
Reepalu, Anton LU
; Arimide, Dawit A
LU
; Balcha, Taye T
LU
; Yeba, Habtamu
; Zewdu, Adinew
; Medstrand, Patrik
LU
and Björkman, Per
LU
(2021)
In Open Forum Infectious Diseases
8(4).
- Abstract
BACKGROUND: The increasing prevalence of antiretroviral drug resistance in Sub-Saharan Africa threatens the success of HIV programs. We have characterized patterns of drug resistance mutations (DRMs) during the initial year of antiretroviral treatment (ART) in HIV-positive adults receiving care at Ethiopian health centers and investigated the impact of tuberculosis on DRM acquisition.
METHODS: Participants were identified from a cohort of ART-naïve individuals aged ≥18 years, all of whom had been investigated for active tuberculosis at inclusion. Individuals with viral load (VL) data at 6 and/or 12 months after ART initiation were selected for this study. Genotypic testing was performed on samples with VLs ≥500 copies/mL obtained... (More)
BACKGROUND: The increasing prevalence of antiretroviral drug resistance in Sub-Saharan Africa threatens the success of HIV programs. We have characterized patterns of drug resistance mutations (DRMs) during the initial year of antiretroviral treatment (ART) in HIV-positive adults receiving care at Ethiopian health centers and investigated the impact of tuberculosis on DRM acquisition.
METHODS: Participants were identified from a cohort of ART-naïve individuals aged ≥18 years, all of whom had been investigated for active tuberculosis at inclusion. Individuals with viral load (VL) data at 6 and/or 12 months after ART initiation were selected for this study. Genotypic testing was performed on samples with VLs ≥500 copies/mL obtained on these occasions and on pre-ART samples from those with detectable DRMs during ART. Logistic regression analysis was used to investigate the association between DRM acquisition and tuberculosis.
RESULTS: Among 621 included individuals (110 [17.5%] with concomitant tuberculosis), 101/621 (16.3%) had a VL ≥500 copies/mL at 6 and/or 12 months. DRMs were detected in 64/98 cases with successful genotyping (65.3%). DRMs were detected in 7/56 (12.5%) pre-ART samples from these individuals. High pre-ART VL and low mid-upper arm circumference were associated with increased risk of DRM acquisition, whereas no such association was found for concomitant tuberculosis.
CONCLUSIONS: Among adults receiving health center-based ART in Ethiopia, most patients without virological suppression during the first year of ART had detectable DRM. Acquisition of DRM during this period was the dominant cause of antiretroviral drug resistance in this setting. Tuberculosis did not increase the risk of DRM acquisition.
(Less)
- author
- Reepalu, Anton
LU
; Arimide, Dawit A
LU
; Balcha, Taye T
LU
; Yeba, Habtamu
; Zewdu, Adinew
; Medstrand, Patrik
LU
and Björkman, Per
LU
- organization
- publishing date
- 2021
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- drug resistance, Ethiopia, HIV, primary health care, tuberculosis
- in
- Open Forum Infectious Diseases
- volume
- 8
- issue
- 4
- article number
- ofab106
- publisher
- Oxford University Press
- external identifiers
-
- pmid:34805444
- scopus:85131714117
- ISSN
- 2328-8957
- DOI
- 10.1093/ofid/ofab106
- project
- The HIV epidemic in Ethiopia – dynamics of viral transmissions and prevalence of transmitted drug resistance
- The HIV-1 epidemic in Ethiopia – transmission patterns, antiretroviral drug resistance and treatment outcomes
- language
- English
- LU publication?
- yes
- id
- 61d5ddb3-73b8-409f-99e9-59ef3f4a4173
- date added to LUP
- 2021-09-08 10:00:18
- date last changed
- 2022-08-17 08:27:57
@article{61d5ddb3-73b8-409f-99e9-59ef3f4a4173,
abstract = {{<p>BACKGROUND: The increasing prevalence of antiretroviral drug resistance in Sub-Saharan Africa threatens the success of HIV programs. We have characterized patterns of drug resistance mutations (DRMs) during the initial year of antiretroviral treatment (ART) in HIV-positive adults receiving care at Ethiopian health centers and investigated the impact of tuberculosis on DRM acquisition.</p><p>METHODS: Participants were identified from a cohort of ART-naïve individuals aged ≥18 years, all of whom had been investigated for active tuberculosis at inclusion. Individuals with viral load (VL) data at 6 and/or 12 months after ART initiation were selected for this study. Genotypic testing was performed on samples with VLs ≥500 copies/mL obtained on these occasions and on pre-ART samples from those with detectable DRMs during ART. Logistic regression analysis was used to investigate the association between DRM acquisition and tuberculosis.</p><p>RESULTS: Among 621 included individuals (110 [17.5%] with concomitant tuberculosis), 101/621 (16.3%) had a VL ≥500 copies/mL at 6 and/or 12 months. DRMs were detected in 64/98 cases with successful genotyping (65.3%). DRMs were detected in 7/56 (12.5%) pre-ART samples from these individuals. High pre-ART VL and low mid-upper arm circumference were associated with increased risk of DRM acquisition, whereas no such association was found for concomitant tuberculosis.</p><p>CONCLUSIONS: Among adults receiving health center-based ART in Ethiopia, most patients without virological suppression during the first year of ART had detectable DRM. Acquisition of DRM during this period was the dominant cause of antiretroviral drug resistance in this setting. Tuberculosis did not increase the risk of DRM acquisition.</p>}},
author = {{Reepalu, Anton and Arimide, Dawit A and Balcha, Taye T and Yeba, Habtamu and Zewdu, Adinew and Medstrand, Patrik and Björkman, Per}},
issn = {{2328-8957}},
keywords = {{drug resistance; Ethiopia; HIV; primary health care; tuberculosis}},
language = {{eng}},
number = {{4}},
publisher = {{Oxford University Press}},
series = {{Open Forum Infectious Diseases}},
title = {{Drug Resistance in HIV-Positive Adults During the Initial Year of Antiretroviral Treatment at Ethiopian Health Centers}},
url = {{http://dx.doi.org/10.1093/ofid/ofab106}},
doi = {{10.1093/ofid/ofab106}},
volume = {{8}},
year = {{2021}},
}