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102 results on '"Virological suppression"'

101. Virological Suppression and Patterns of Resistance Amongst Patients on Antiretroviral Therapy at 4 Nigerian Military Hospitals.

Author

Babajide K, Ayemoba O, Terfa K, Ake J, Crowell TA, Adamu Y, Mohammed T, Okoye I, Odeyemi S, Crawford K, Hughes L, Akintunde E, Umar T, Hamm TE, and Njoku OS

Subjects
Adolescent, Adult, Cross-Sectional Studies, Drug Resistance, Viral, Female, Genotype, Genotyping Techniques, HIV-1 classification, HIV-1 genetics, Humans, Male, Middle Aged, Mutation, Missense, Nigeria, RNA, Viral blood, Viral Load, Young Adult, Anti-Retroviral Agents therapeutic use, HIV Infections drug therapy, HIV Infections virology, HIV-1 isolation & purification, Hospitals, Military, Military Personnel, Sustained Virologic Response
Abstract

Background: In resource-constrained settings, plasma HIV-1 RNA quantification has not been routinely available for the monitoring of response to antiretroviral therapy. This study evaluated virological suppression rates amongst patients on first-line ART in four Nigerian military hospitals., Methods: We conducted a cross-sectional study of 325 randomly selected adult clinic clients (≥18 years old) on first-line ART regimens at four Nigerian military hospitals. Plasma HIV-1 RNA was assayed using a Roche COBAS TaqMan48 with High Pure System. Virological failure was defined as HIV-1 RNA >1000 copies/ml. Specimens with HIV-1 RNA >1000 copies/ml were referred for genotyping., Results: HIV-1 RNA results were obtained in 322 participants. Two hundred and seventy-eight study participants (86.3%) had HIV viral RNA < 1000 copies/ml, including 273 (84.8%) with HIV- 1 RNA <400 copies/ml. HIV drug resistance genotyping results were obtained in 35 of 44 study participants with HIV-1 RNA >1000 copies/ml. Only 14% (5/35) had no resistance mutations. Of the remainder, 10% (3/30) had no nucleoside analogue mutations while 33% (10/30) had only M184V along with non-nucleoside reverse transcriptase inhibitor (NNRTI) mutations (K103N or Y188C). 25% (5/25) of participants failing on Zidovudine had more than two thymidine analogue mutations (TAMs)., Conclusion: We observed a high virological suppression rate among the study participants. However, a large proportion of virologically unsuppressed clients had identifiable resistance mutations. The study demonstrates that viral load monitoring is feasible at Nigerian military hospitals and supports the current WHO HIV treatment guidelines which emphasize virological monitoring of patients on ART for early detection of treatment failure., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.)

Published
2017
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102. Virological success of lopinavir/ritonavir salvage regimen is affected by an increasing number of lopinavir/ritonavir-related mutations

Author

Fulvio Adorni, Simona Landonio, Laura Cordier, Amedeo Capetti, Federica Tordato, Antonietta Cargnel, Marco Bongiovanni, Paola Meraviglia, Elisabetta Chiesa, Teresa Bini, Paola Cicconi, Stefano Rusconi, and Antonella d'Arminio Monforte

Subjects
Adult, Male, Settore MED/17 - Malattie Infettive, Anti-HIV Agents, medicine.medical_treatment, Lopinavir/ritonavir, HIV Infections, Pyrimidinones, Lopinavir, Drug Resistance, Multiple, Viral, Salvage regimen, Humans, Medicine, Pharmacology (medical), Protease inhibitor (pharmacology), Viremia, Sida, Proportional Hazards Models, Salvage Therapy, Pharmacology, Chemotherapy, Ritonavir, drug resistance, biology, ACTIVE ANTIRETROVIRAL THERAPY, INHIBITOR-EXPERIENCED PATIENTS, LOPINAVIR-RITONAVIR, HIV-INFECTION, PROTEASE, COHORT, RESISTANCE, MORTALITY, FAILURE, AIDS, business.industry, virus diseases, HIV, biology.organism_classification, Virology, CD4 Lymphocyte Count, Infectious Diseases, Mutation, Lentivirus, HIV-1, Female, business, virological suppression, medicine.drug
Abstract

We evaluated the virological outcome of lopinavir/ritonavir (LPV/RTV) in 224 HIV-1-infected and protease inhibitor (PI)-experienced patients showing virological failure to a highly active antiretroviral therapy (HAART) regimen and followed up for at least 3 months. At baseline, the median level of plasma viraemia was 4.61 log10 copies/ml (range 3–6.48) and the median CD4 cell count was 219 cells/mm3 (range 1–836). During a median follow-up of 272 days (range 92–635), we observed an increase in the number of CD4 cells (P=0.02) and a dramatic decrease in plasma viraemia levels (P=0.0001), which became undetectable in 122 patients (54.5%). The closely related predictive factors were baseline plasma viraemia levels and the number of mutations known to reduce susceptibility to LPV/RTV. Thirty-one patients (13.8%) discontinued LPV/RTV during the follow-up, and one AIDS event and three deaths were recorded. Of the 134 patients (59.8%) who underwent a baseline genotype resistance test, 22 (16.4%) had ≥6 mutations known to reduce LPV/RTV susceptibility; plasma viraemia became undetectable in 76 patients (56.7%), only five of whom harboured ≥6 mutations at baseline (P=0.0001). The independent predictive factors related to virological success were plasma viraemia levels and the number of mutations reducing susceptibility to LPV/RTV at baseline; each additional log10 copies/ml of HIV RNA reduced the probability of virological success by 34.0% and each extra mutation by 14.5%.

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