The relative contributions of HIV drug resistance, nonadherence and low-level viremia to viremic episodes on antiretroviral therapy in sub-Saharan Africa

Abstract

24 mon h (af er VE a 12 mon h ). We ed adj ed odd ra io from m l i ariable logi ic regre ion o e ima e a rib able frac ion for each ri k fac or. Re l : Of 2,737 cohor par icipan , 1,935 had da a on pre-rea men dr gre i ance (PDR) and a lea 1 VL o come. Viral non-ppre ion epi ode (173/1,935 [8.9%]) ere a rib able o non-adherence in 30% (35% in men 24% in omen) and o PDR o NNRTI in 10% (15% in omen 6% in men). No abl , a con emporar PDR pre alence of 10-25%, PDR o ld e plain 13-30% of iral nonppre ion. Virological rebo nd epi ode (96/1,515 [6.3%]) ere mo l a rib able o LLV (29%) and non-adherence (14%), and onl rarel o PDR (1.1%). Fail re o achie e iral re-ppre ion (66/81 [81.5%]) ere mo l a rib able o he pre ence of acq ired dr g re i ance (34%) and onl rarel o non-adherence (2.4%). Concl ion : Effec i e adherence in er en ion co ld b an iall red ce iral nonppre ion (e peciall in men) and irological rebo nd (e peciall d ring LLV), b o ld ha e limi ed effec on impro ing iral re-ppre ion. Al erna i e ART regimen co ld circ m en PDR and acq ired re i ance.

Who’s slipping through the cracks? A comprehensive individual, clinical and health system characterization of people with virological failure on first‐line HIV treatment in Uganda and South Africa

“…HIVDR testing was completed for one arm of the study and confirmed a hypothesis of high rates of HIVDR: 90% (95% CI 86-93%) had Stanforddefined HIVDR mutations. These levels of HIVDR are similar to those found in other studies in the region [25,26]. Prior studies also found similarly high rates of HIVDR despite optimal adherence [27,28].…”

Persistent low-Level viremia in persons living with HIV undertreatment: An unresolved status

“…Pereira et al (2019) found no association between VF and the presence of HIVDR in pLLV patients [ 38 ]. While the presence of HIVDR hinders the ability to achieve undetectable viral load (uVL), it does not appear to be responsible for virological rebound events observed after virological suppression [ 50 ].…”

“…Most studies published suggest that factors such as ART adherence difficulties and viral genotype resistance could be the main cause of pLLV in HIV patients, as we have previously reviewed [ 34 , 36–38 , 40 , 50 ]. However, although pLLV status does not seem to be a random biological phenomenon [ 54 ], the origin of this phenomenon remains unclear and the source(s) and mechanism(s) continue to be largely undescribed.…”

Factors Associated with the Effectiveness of National Free Antiretroviral Treatment Program in HIV Infected Patients of Yi Nationality from Southwest China: Evidence from A Cohort Study to Provide Clues for Improvement

“…Thus, this study delineates detailed There is the possibility that longer follow-up are required to explicitly disclose the influence of LLV on clinical outcomes.Besides, for such observations, more frequent monitoring such as every 3 or 6 months should be necessary to more aptly delineate the VL dynamics during ART. PDR) to NRTIs in 10%(18). Notably, at contemporary PDR prevalence of 10-25%, PDR would explain 13-30% of viral non-suppression(18).…”

“…PDR) to NRTIs in 10%(18). Notably, at contemporary PDR prevalence of 10-25%, PDR would explain 13-30% of viral non-suppression(18). PDR has been one of the epidemic characteristics in Liangshan area.…”