Low Primary and Secondary HIV Drug-Resistance after 12 Months of Antiretroviral Therapy in Human Immune-Deficiency Virus Type 1 (HIV-1)-Infected Individuals from Kigali, Rwanda

Abstract

Treatment outcomes of HIV patients receiving antiretroviral therapy (ART) in Rwanda are scarcely documented. HIV viral load (VL) and HIV drug-resistance (HIVDR) outcomes at month 12 were determined in a prospective cohort study of antiretroviral–naïve HIV patients initiating first-line therapy in Kigali. Treatment response was monitored clinically and by regular CD4 counts and targeted HIV viral load (VL) to confirm drug failure. VL measurements and HIVDR genotyping were performed retrospectively on baseline and month 12 samples. One hundred and fifty-eight participants who completed their month 12 follow-up visit had VL data available at month 12. Most of them (88%) were virologically suppressed (VL≤1000 copies/mL) but 18 had virological failure (11%), which is in the range of WHO-suggested targets for HIVDR prevention. If only CD4 criteria had been used to classify treatment response, 26% of the participants would have been misclassified as treatment failure. Pre-therapy HIVDR was documented in 4 of 109 participants (3.6%) with an HIVDR genotyping results at baseline. Eight of 12 participants (66.7%) with virological failure and HIVDR genotyping results at month 12 were found to harbor mutation(s), mostly NNRTI resistance mutations, whereas 4 patients had no HIVDR mutations. Almost half (44%) of the participants initiated ART at CD4 count ≤200cell/µl and severe CD4 depletion at baseline (<50 cells/µl) was associated with virological treatment failure (p = 0.008).Although the findings may not be generalizable to all HIV patients in Rwanda, our data suggest that first-line ART regimen changes are currently not warranted. However, the accumulation of acquired HIVDR mutations in some participants underscores the need to reinforce HIVDR prevention strategies, such as increasing the availability and appropriate use of VL testing to monitor ART response, ensuring high quality adherence counseling, and promoting earlier identification of HIV patients and enrollment into HIV care and treatment programs.

Drug resistance mutations after the first 12 months on antiretroviral therapy and determinants of virological failure in Rwanda

“…found that M184V was predominant (43.6%) in Kenya , and the predominance of M184V and K103N was found by Rusine et al . and Ziada El‐Khatib . However, the predominance of K65R in our study differs from other studies mentioned due to use of TDF instead of thymidine analogue‐based regimen.…”

“…Viral suppression results were comparable to those found by Rusine et al . in a smaller prospective cohort of 213 patients on ART in Kigali where 86% achieved HIV viral suppression . Another retrospective study conducted in Rwanda by Frank et al .…”

“…Genotyping tests performed on eight patients in a Rwandan study evaluating drug resistance mutations (DRMs) among patients on first‐line ART found two cases with thymidine analogue mutations (TAMs) . The mutations included D67N, K70R and K219Q in one case and D67N and K70R in the other . Likewise, Mutwa et al .…”

“…According to a systematic review in 2011, the overall transmitted HIV drug resistance in RLS was 6.6% and negatively impacted outcomes of first‐line ART . Genotyping tests performed on eight patients in a Rwandan study evaluating drug resistance mutations (DRMs) among patients on first‐line ART found two cases with thymidine analogue mutations (TAMs) . The mutations included D67N, K70R and K219Q in one case and D67N and K70R in the other .…”

Treatment Failure, Drug Resistance, and CD4 T-Cell Count Decline Among Postpartum Women on Antiretroviral Therapy in South Africa

“…These findings are slightly better than the 29% failure we observed at 12 months. Notably, these outcomes are worse than recent reports from general adult ART clinics ranging from 9 to 16% virologic failure [31-33]. Other pregnancy-related studies have reported a high rate of loss from follow-up, but have not included virologic outcomes [14, 16, 34].…”