Virological failure and HIV drug resistance among adults living with HIV on second-line antiretroviral therapy in the Asia-Pacific
Document Type
Article
Publication Date
3-1-2021
Abstract
To assess second-line antiretroviral therapy (ART) virological failure and HIV drug resistance-associated mutations (RAMs), in support of third-line regimen planning in Asia. Methods Adults > 18 years of age on second-line ART for >= 6 months were eligible. Cross-sectional data on HIV viral load (VL) and genotypic resistance testing were collected or testing was conducted between July 2015 and May 2017 at 12 Asia-Pacific sites. Virological failure (VF) was defined as VL > 1000 copies/mL with a second VL > 1000 copies/mL within 3-6 months. FASTA files were submitted to Stanford University HIV Drug Resistance Database and RAMs were compared against the IAS-USA 2019 mutations list. VF risk factors were analysed using logistic regression. Results Of 1378 patients, 74% were male and 70% acquired HIV through heterosexual exposure. At second-line switch, median interquartile range (IQR)] age was 37 (32-42) years and median (IQR) CD4 count was 103 (43.5-229.5) cells/mu L; 93% received regimens with boosted protease inhibitors (PIs). Median duration on second line was 3 years. Among 101 patients (7%) with VF, CD4 count > 200 cells/mu L at switch odds ratio (OR) = 0.36, 95% confidence interval (CI): 0.17-0.77 vs. CD4 <= 50) and HIV exposure through male-male sex (OR = 0.32, 95% CI: 0.17-0.64 vs. heterosexual) or injecting drug use (OR = 0.24, 95% CI: 0.12-0.49) were associated with reduced VF. Of 41 (41%) patients with resistance data, 80% had at least one RAM to nonnucleoside reverse transcriptase inhibitors (NNRTIs), 63% to NRTIs, and 35% to PIs. Of those with PI RAMs, 71% had two or more. Conclusions There were low proportions with VF and significant RAMs in our cohort, reflecting the durability of current second-line regimens.
Keywords
Asia, Drug resistance, HIV, Line antiretroviral therapy, Virological failure
Divisions
fac_med
Funders
United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Institute of Allergy & Infectious Diseases (NIAID),US National Institutes of Health's Eunice Kennedy Shriver National Institute of Child Health and Human Development,US National Institutes of Health's National Cancer Institute,US National Institutes of Health's National Institute of Mental Health,US National Institutes of Health's National Institute on Drug Abuse,United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Heart Lung & Blood Institute (NHLBI),United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Institute on Alcohol Abuse & Alcoholism (NIAAA),United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK),Fogarty International Center, as part of the International Epidemiology Databases to Evaluate AIDS (IeDEA)[U01AI069907],Australian Government Department of Health & Ageing,Faculty of Medicine, UNSW Sydney,ViiV Healthcare
Publication Title
HIV Medicine
Volume
22
Issue
3
Publisher
Wiley
Publisher Location
111 RIVER ST, HOBOKEN 07030-5774, NJ USA