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Increasing Prevalence of HIV Pretreatment Drug Resistance in Women But Not Men in Rural Uganda During 2005-2013
- Source :
- AIDS patient care and STDs, vol 32, iss 7
- Publication Year :
- 2018
- Publisher :
- eScholarship, University of California, 2018.
-
Abstract
- The prevalence of HIV pretreatment drug resistance (PDR) is increasing in sub-Saharan Africa. We sought to describe correlates of PDR and evaluate effects of PDR on clinical outcomes in rural Uganda. We analyzed data from the Uganda AIDS Rural Treatment Outcomes study, a cohort of antiretroviral therapy (ART)-naive adults with HIV (2005–2015). We performed resistance testing on pre-ART specimens. We defined PDR as any World Health Organization (WHO) 2009 surveillance drug resistance mutation and classified PDR level using the Stanford algorithm. We fit unadjusted and sex-stratified log binomial regression and Cox proportional hazard models to identify correlates of PDR and the impact of PDR on viral suppression, loss to follow-up (LTFU), and death. We analyzed data from 738 participants (median age 33 years, 69% female). Overall, prevalence of PDR was 3.5% (n = 26), owing mostly to resistance to non-nucleoside reverse transcriptase inhibitors. PDR increased over time in women (1.8% in those enrolling in clinic in 2001–2006, vs. 7.0% in 2007–2013; p = 0.006), but not in men (1.15% vs. 0.72%, p = 0.737). Lower pre-ART log(10) HIV RNA was also associated with higher prevalence of PDR. We identified longer time to viral suppression among those with PDR compared with without PDR (0.5 and 0.3 years, respectively, p = 0.023), but there was no significant relationship with mortality or LTFU (p = 0.139). We observed increasing rates of PDR in women in southwestern Uganda. Implications of this trend, particularly to prevention of mother-to-child transmission programs in the region, require attention due to delayed viral suppression among those with PDR.
- Subjects :
- 0301 basic medicine
Rural Population
sub-Saharan Africa
endocrine system diseases
Human immunodeficiency virus (HIV)
Drug Resistance
HIV Infections
Drug resistance
medicine.disease_cause
Cohort Studies
0302 clinical medicine
Prevalence
Medicine
Uganda
030212 general & internal medicine
Viral suppression
Longitudinal Studies
Viral
Clinical and Epidemiologic Research
Viral Load
Infectious Diseases
Anti-Retroviral Agents
5.1 Pharmaceuticals
6.1 Pharmaceuticals
Public Health and Health Services
HIV/AIDS
Female
Development of treatments and therapeutic interventions
Infection
Adult
medicine.medical_specialty
viral suppression
Anti-HIV Agents
030106 microbiology
antiretroviral therapy
resistance
03 medical and health sciences
Sex Factors
Clinical Research
Internal medicine
Virology
Drug Resistance, Viral
parasitic diseases
Humans
cardiovascular diseases
business.industry
Prevention
Public Health, Environmental and Occupational Health
Evaluation of treatments and therapeutic interventions
Antiretroviral therapy
eye diseases
Good Health and Well Being
Mutation
HIV-1
sense organs
business
Subjects
Details
- Database :
- OpenAIRE
- Journal :
- AIDS patient care and STDs, vol 32, iss 7
- Accession number :
- edsair.doi.dedup.....b216826a14695976db5cafffcb2fc807