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DC Field | Value | Language |
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dc.contributor.author | Kantor, R | - |
dc.contributor.author | Buziba, Nathan | - |
dc.contributor.author | Diero, Lameck | - |
dc.date.accessioned | 2021-02-02T11:37:11Z | - |
dc.date.available | 2021-02-02T11:37:11Z | - |
dc.date.issued | 2018-11 | - |
dc.identifier.uri | https://pubmed.ncbi.nlm.nih.gov/30134290/ | - |
dc.identifier.uri | http://ir.mu.ac.ke:8080/jspui/handle/123456789/4058 | - |
dc.description.abstract | Objective: Characterize failure and resistance above and below guidelines-recommended 1000 copies/ml virologic threshold, upon second-line failure. Design: Cross-sectional study. Methods: Kenyan adults on lopinavir/ritonavir-based second-line were enrolled at AMPATH (Academic Model Providing Access to Healthcare). Charts were reviewed for demographic/clinical characteristics and CD4/viral load were obtained. Participants with detectable viral load had a second visit and pol genotyping was attempted in both visits. Accumulated resistance was defined as mutations in the second, not the first visit. Low-level viremia (LLV) was detectable viral load less than 1000 copies/ml. Failure and resistance associations were evaluated using logistic and Poisson regression, Fisher Exact and t-tests. Results: Of 394 participants (median age 42, 60% women, median 1.9 years on second-line) 48% had detectable viral load; 21% had viral load more than 1000 copies/ml, associated with younger age, tuberculosis treatment, shorter time on second-line, lower CD4count/percentage, longer first-line treatment interruption and pregnancy. In 105 sequences from the first visit (35 with LLV), 79% had resistance (57% dual-class, 7% triple-class; 46% with intermediate-to-high-level resistance to ≥1 future drug option). LLV was associated with more overall and NRTI-associated mutations and with predicted resistance to more next-regimen drugs. In 48 second-visit sequences (after median 55 days; IQR 28-33), 40% accumulated resistance and LLV was associated with more mutation accumulation. Conclusion: High resistance upon second-line failure exists at levels above and below guideline-recommended virologic-failure threshold, impacting future treatment options. Optimization of care should include increased viral load monitoring, resistance testing and third-line ART access, and consideration of lowering the virologic failure threshold, though this demands further investigation. | en_US |
dc.language.iso | en | en_US |
dc.publisher | PubMed | en_US |
dc.subject | HIV | en_US |
dc.subject | Drug resistance | en_US |
dc.subject | High-level and Low-level Viremia | en_US |
dc.title | HIV-1 second-line failure and drug resistance at high-level and low-level viremia in Western Kenya | en_US |
dc.type | Article | en_US |
Appears in Collections: | School of Medicine |
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