Determinants of virological failure and antiretroviral drug resistance in Mozambique
Por:
Ruperez, M, Pou, C, Maculuve, S, Cedeno, S, Luis, L, Rodriguez, J, Letang, E, Molto, J, Macete, E, Clotet, B, Alonso, P, Menendez, C, Naniche, D and Paredes, R
Publicada:
1 sep 2015
Resumen:
Objectives: The objective of this study was to inform public health actions to limit first-line ART failure and HIV drug resistance in Mozambique.
Methods: This was a cross-sectional study. HIV-1-infected adults on first-line ART for at least 1 year attending routine visits in the Manhic, a District Hospital, in a semi-rural area in southern Mozambique with no HIV-1 RNA monitoring available, were evaluated for clinical, socio-demographic, therapeutic, immunological and virological characteristics. Factors associated with HIV-1 RNA >= 1000 copies/mL and HIV drug resistance were determined using multivariate logistic regression.
Results: The study included 334 adults on first-line ART for a median of 3 years, of which 65% (214/332) had suppressed viraemia, 11% (37/332) had low-level viraemia (HIV-1 RNA 150-999 copies/mL) and 24% (81/332) had overt virological failure (HIV-1 RNA >= 1000 copies/mL). HIV drug resistance was detected in 89% of subjects with virological failure, but in none with low-level viraemia. Younger age [OR = 0.97 per additional year (95% CI = 0.94-1.00), P = 0.039], ART initiation at WHO stage III/IV [OR = 2.10 (95% CI = 1.23-3.57), P = 0.003] and low ART adherence [OR = 2.69 (95% CI = 1.39-5.19), P = 0.003] were associated with virological failure. Longer time on ART [OR = 1.55 per additional year (95% CI = 1.00-2.43), P = 0.052] and illiteracy [OR = 0.24 (95% CI = 0.07-0.89), P = 0.033] were associated with HIV drug resistance. Compared with HIV-1 RNA, clinician's judgement of ART failure, based on clinical and immunological outcomes, only achieved 29% sensitivity and misdiagnosed 1 out of every 4.5 subjects.
Conclusions: Public health programmes in Mozambique should focus on early HIV diagnosis, early ART initiation and adherence support. Virological monitoring drastically improves the diagnosis of ART failure, enabling a better use of resources.
Filiaciones:
Ruperez, M:
Hlth Res Ctr CISM, Manhica, Maputo, Mozambique
Univ Barcelona, Barcelona Inst Global Hlth, Barcelona Ctr Int Hlth Res, Hosp Clin,CRESIB,ISGlobal, Barcelona, Spain
Pou, C:
IrsiCaixa AIDS Res Inst, Badalona, Catalonia, Spain
Maculuve, S:
Hlth Res Ctr CISM, Manhica, Maputo, Mozambique
:
IrsiCaixa AIDS Res Inst, Badalona, Catalonia, Spain
Luis, L:
Hlth Res Ctr CISM, Manhica, Maputo, Mozambique
Rodriguez, J:
IrsiCaixa AIDS Res Inst, Badalona, Catalonia, Spain
Letang, E:
Univ Barcelona, Barcelona Inst Global Hlth, Barcelona Ctr Int Hlth Res, Hosp Clin,CRESIB,ISGlobal, Barcelona, Spain
Swiss Trop & Publ Hlth Inst Swiss TPH, Basel, Switzerland
:
Hosp Univ Germans Trias i Pujol, Lluita Sida Fdn, HIV Unit, Badalona, Catalonia, Spain
Macete, E:
Hlth Res Ctr CISM, Manhica, Maputo, Mozambique
:
IrsiCaixa AIDS Res Inst, Badalona, Catalonia, Spain
Hosp Univ Germans Trias i Pujol, Lluita Sida Fdn, HIV Unit, Badalona, Catalonia, Spain
Univ Vic Univ Cent Catalunya, Vic, Catalonia, Spain
Alonso, P:
Hlth Res Ctr CISM, Manhica, Maputo, Mozambique
Univ Barcelona, Barcelona Inst Global Hlth, Barcelona Ctr Int Hlth Res, Hosp Clin,CRESIB,ISGlobal, Barcelona, Spain
Menendez, C:
Hlth Res Ctr CISM, Manhica, Maputo, Mozambique
Univ Barcelona, Barcelona Inst Global Hlth, Barcelona Ctr Int Hlth Res, Hosp Clin,CRESIB,ISGlobal, Barcelona, Spain
Naniche, D:
Hlth Res Ctr CISM, Manhica, Maputo, Mozambique
Univ Barcelona, Barcelona Inst Global Hlth, Barcelona Ctr Int Hlth Res, Hosp Clin,CRESIB,ISGlobal, Barcelona, Spain
:
IrsiCaixa AIDS Res Inst, Badalona, Catalonia, Spain
Hosp Univ Germans Trias i Pujol, Lluita Sida Fdn, HIV Unit, Badalona, Catalonia, Spain
Univ Vic Univ Cent Catalunya, Vic, Catalonia, Spain
Bronze, Green Published
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