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Determinants of virological failure and antiretroviral drug resistance in Mozambique

Rupérez, María ; Pou, Christian ; Maculuve, Sonia ; Cedeño, Samandhy ; Luis, Leopoldina ; Rodríguez, Judith ; Letang, Emilio ; Moltó, José ; Macete, Eusébio ; Clotet, Bonaventura ; Alonso, Pedro ; Menéndez, Clara ; Naniche, Denise ; Paredes, Roger

In: Journal of Antimicrobial Chemotherapy, 2015, vol. 70, no. 9, p. 2639-2647

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    Title
    • Determinants of virological failure and antiretroviral drug resistance in Mozambique
    Author
    • Rupérez, María. Manhiça Health Research Center (CISM), Manhiça, Maputo, Mozambique
    • Pou, Christian. IrsiCaixa AIDS Research Institute, Badalona, Catalonia, Spain
    • Maculuve, Sonia. Manhiça Health Research Center (CISM), Manhiça, Maputo, Mozambique
    • Cedeño, Samandhy. IrsiCaixa AIDS Research Institute, Badalona, Catalonia, Spain
    • Luis, Leopoldina. Manhiça Health Research Center (CISM), Manhiça, Maputo, Mozambique
    • Rodríguez, Judith. IrsiCaixa AIDS Research Institute, Badalona, Catalonia, Spain
    • Letang, Emilio. Barcelona Centre for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
    • Moltó, José. Lluita Contra la Sida Foundation, HIV Unit, Hosp Univ Germans Trias i Pujol, Badalona, Catalonia, Spain
    • Macete, Eusébio. Manhiça Health Research Center (CISM), Manhiça, Maputo, Mozambique
    • Clotet, Bonaventura. IrsiCaixa AIDS Research Institute, Badalona, Catalonia, Spain
    • Alonso, Pedro. Manhiça Health Research Center (CISM), Manhiça, Maputo, Mozambique
    • Menéndez, Clara. Manhiça Health Research Center (CISM), Manhiça, Maputo, Mozambique
    • Naniche, Denise. Manhiça Health Research Center (CISM), Manhiça, Maputo, Mozambique
    • Paredes, Roger. IrsiCaixa AIDS Research Institute, Badalona, Catalonia, Spain
    Document Type
    • Postprint
    Language
    • English
    Published in
    • Journal of Antimicrobial Chemotherapy, 2015, vol. 70, no. 9, p. 2639-2647. Oxford University Press
    Other Version
    OAI-PMH Identifier
    • oai:doc.rero.ch:296402
    Summary
    Objectives The objective of this study was to inform public health actions to limit first-line ART failure and HIV drug resistance in Mozambique. Methods This was a cross-sectional study. HIV-1-infected adults on first-line ART for at least 1 year attending routine visits in the Manhiça District Hospital, in a semi-rural area in southern Mozambique with no HIV-1 RNA monitoring available, were evaluated for clinical, socio-demographic, therapeutic, immunological and virological characteristics. Factors associated with HIV-1 RNA ≥1000 copies/mL and HIV drug resistance were determined using multivariate logistic regression. Results The study included 334 adults on first-line ART for a median of 3 years, of which 65% (214/332) had suppressed viraemia, 11% (37/332) had low-level viraemia (HIV-1 RNA 150-999 copies/mL) and 24% (81/332) had overt virological failure (HIV-1 RNA ≥1000 copies/mL). HIV drug resistance was detected in 89% of subjects with virological failure, but in none with low-level viraemia. Younger age [OR = 0.97 per additional year (95% CI = 0.94-1.00), P = 0.039], ART initiation at WHO stage III/IV [OR = 2.10 (95% CI = 1.23-3.57), P = 0.003] and low ART adherence [OR = 2.69 (95% CI = 1.39-5.19), P = 0.003] were associated with virological failure. Longer time on ART [OR = 1.55 per additional year (95% CI = 1.00-2.43), P = 0.052] and illiteracy [OR = 0.24 (95% CI = 0.07-0.89), P = 0.033] were associated with HIV drug resistance. Compared with HIV-1 RNA, clinician's judgement of ART failure, based on clinical and immunological outcomes, only achieved 29% sensitivity and misdiagnosed 1 out of every 4.5 subjects. Conclusions Public health programmes in Mozambique should focus on early HIV diagnosis, early ART initiation and adherence support. Virological monitoring drastically improves the diagnosis of ART failure, enabling a better use of resources