Objective We sought to determine the rate of the K65R mutation in patients receiving tenofovir (TDF)-based antiretroviral treatment (ART) with subtype C HIV infection. Design Retrospective cohort study. Methods All patients initiated on d4T+3TC or TDF+3TC plus a NNRTI at McCord Hospital in Durban, South Africa had their charts reviewed. All patients with virologic failure (VF), defined as a viral load (VL) > 1000 copies/mL after 5 months of a first ART regimen, had genotypic resistance testing performed prospectively using a validated in-house assay. Important resistance mutations were selected based upon published mutations in subtype B virus in the Stanford HIV Drug Resistance (DR) Database. Results A total of 585 patients were initiated on TDF-containing first-line ART from August 3, 2010 to March 17, 2011. Thirty-five (6.0%) of these patients had VF and 23/33 (69.7%) of the VF patients had the K65R mutation. The median (IQR) for the baseline CD4 count was 105 cells/uL (49-209) and VL at VF was 47,571 copies/mL (20,708-202,000). During the same time period, 53 patients were initiated on d4T-containing regimens. Two (3.8%) of these patients had VF and 1 of the VF patients had the K65R mutation. Conclusions Preliminary data show very high rates (>65%) of K65R for patients failing TDF-based first-line regimens at McCord hospital with few additional NRTI mutations compared to subtype B. These rates may reflect faster in vivo selection, longer time on a failing regimen, or transmitted DR.

Despite similar durations of HIV infection and equal access to health care, AAs were significantly less likely to achieve viral suppression compared with EA.

The concurrent use of traditional African medicine (TAM) and allopathic medicine is not well understood for people living with HIV (PLHIV) in the era of antiretroviral therapy (ART). This cross-sectional, qualitative study examines perceptions of the concurrent use of TAM and ART among: i) patients receiving ART at the Sinikithemba HIV Clinic of McCord Hospital, in Durban, South Africa; ii) allopathic medical providers (doctors, nurses, HIV counsellors) from Sinikithemba; and iii) local traditional healers. Data were collected through in-depth interviews and focus group discussions with 26 participants between July and October, 2011. Patients in this study did not view TAM as an alternative to ART; rather, results show that patients employ TAM and ART for distinctly different needs. More research is needed to further understand the relationship between traditional and allopathic approaches to health care in South Africa, to improve cultural relevance in the provision and delivery of care for PLHIV, and to pragmatically address the concerns of healthcare providers and public health officials managing this intersection in South Africa and elsewhere.

We sought to develop individual-level Early Warning Indicators (EWI) of virologic failure (VF) for clinicians to use during routine care complementing WHO population-level EWI. A case-control study was conducted at a Durban clinic. Patients after ‡ 5 months of first-line antiretroviral therapy (ART) were defined as cases if they had VF [HIV-1 viral load (VL) > 1000 copies/mL] and controls (2:1) if they had VL £ 1000 copies/mL. Pharmacy refills and pill counts were used as adherence measures. Participants responded to a questionnaire including validated psychosocial and symptom scales. Data were also collected from the medical record. Multivariable logistic regression models of VF included factors associated with VF ( p < 0.05) in univariable analyses. We enrolled 158 cases and 300 controls. In the final multivariable model, male gender, not having an active religious faith, practicing unsafe sex, having a family member with HIV, not being pleased with the clinic experience, symptoms of depression, fatigue, or rash, low CD4 counts, family recommending HIV care, and using a TV/radio as ART reminders (compared to mobile phones) were associated with VF independent of adherence measures. In this setting, we identified several key individual-level EWI associated with VF including novel psychosocial factors independent of adherence measures.

Background Suboptimal adherence to antiretroviral therapy (ART) is a strong predictor of virologic failure (VF) among people with HIV. Various methods such as patient self-report, pill counts and pharmacy refills have been utilized to monitor adherence. However, there are limited data on the accuracy of combining methods to better predict VF in routine clinical settings. We examined various methods to assess adherence including pill count, medication possession ratio (MPR), and self-reported adherence in order to determine which was most highly associated with VF after ≥ 6 months on ART. Methods We conducted a secondary analysis of data from a case-control study. At enrollment, pharmacy refill data were collected retrospectively from the medical chart, pill counts were completed to derive a pill count adherence ratio (PCAR) and a self-report questionnaire was administered to all participants. Parametric smooth splines and receiver operator characteristic (ROC) analyses were carried out to assess the accuracy of the adherence methods. Results 458 patients were enrolled from October 2010 to June 2012. Of these, 158 (34.50%) experienced VF (cases) and 300 (65.50%) were controls. The median (IQR) PCAR was 1.10 (0.99–1.14) for cases and 1.13 (1.08–1.18) for controls (p<0.0001). The median MPR was 1.00 (0.97–1.07) for cases and 1.03 (0.96–1.07) for controls (p=0.83). Combination of PCAR and self-reported questions was highly associated with VF. Conclusion In this setting, a combination of pill count adherence and self-report adherence questions had the highest diagnostic accuracy for VF. Further validation of this simple, low-cost combination is warranted in large prospective studies.