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Virological failure and HIV drug resistance among adults living with HIV on second-line antiretroviral therapy in the Asia-Pacific

To assess second-line antiretroviral therapy (ART) virological failure and HIV drug resistance-associated mutations (RAMs), in support of third-line regimen planning in Asia. Methods Adults > 18 years of age on second-line ART for >= 6 months were eligible. Cross-sectional data on HIV viral lo...

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Main Authors: Ross, Jeremy, Jiamsakul, Awachana, Kumarasamy, Nagalingeswaran, Azwa, Raja Iskandar Shah Raja, Merati, Tuti Parwati, Do, Cuong Dat, Lee, Man-Po, Ly, Penh S., Yunihastuti, Evy, Nguyen, Kinh Van, Ditangco, Rossana, Ng, Oon Tek, Choi, Jun Yong, Oka, S., Sohn, Annette H, Law, Matthew G.
Format: Article
Published: Wiley 2021
Subjects:
R Medicine
RB Pathology
Theories of disease. Etiology. Pathogenesis
Online Access:http://eprints.um.edu.my/34654/
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spelling my.um.eprints.346542022-09-19T04:33:50Z http://eprints.um.edu.my/34654/ Virological failure and HIV drug resistance among adults living with HIV on second-line antiretroviral therapy in the Asia-Pacific Ross, Jeremy Jiamsakul, Awachana Kumarasamy, Nagalingeswaran Azwa, Raja Iskandar Shah Raja Merati, Tuti Parwati Do, Cuong Dat Lee, Man-Po Ly, Penh S. Yunihastuti, Evy Nguyen, Kinh Van Ditangco, Rossana Ng, Oon Tek Choi, Jun Yong Oka, S. Sohn, Annette H Law, Matthew G. R Medicine RB Pathology Theories of disease. Etiology. Pathogenesis To assess second-line antiretroviral therapy (ART) virological failure and HIV drug resistance-associated mutations (RAMs), in support of third-line regimen planning in Asia. Methods Adults > 18 years of age on second-line ART for >= 6 months were eligible. Cross-sectional data on HIV viral load (VL) and genotypic resistance testing were collected or testing was conducted between July 2015 and May 2017 at 12 Asia-Pacific sites. Virological failure (VF) was defined as VL > 1000 copies/mL with a second VL > 1000 copies/mL within 3-6 months. FASTA files were submitted to Stanford University HIV Drug Resistance Database and RAMs were compared against the IAS-USA 2019 mutations list. VF risk factors were analysed using logistic regression. Results Of 1378 patients, 74% were male and 70% acquired HIV through heterosexual exposure. At second-line switch, median interquartile range (IQR)] age was 37 (32-42) years and median (IQR) CD4 count was 103 (43.5-229.5) cells/mu L; 93% received regimens with boosted protease inhibitors (PIs). Median duration on second line was 3 years. Among 101 patients (7%) with VF, CD4 count > 200 cells/mu L at switch odds ratio (OR) = 0.36, 95% confidence interval (CI): 0.17-0.77 vs. CD4 <= 50) and HIV exposure through male-male sex (OR = 0.32, 95% CI: 0.17-0.64 vs. heterosexual) or injecting drug use (OR = 0.24, 95% CI: 0.12-0.49) were associated with reduced VF. Of 41 (41%) patients with resistance data, 80% had at least one RAM to nonnucleoside reverse transcriptase inhibitors (NNRTIs), 63% to NRTIs, and 35% to PIs. Of those with PI RAMs, 71% had two or more. Conclusions There were low proportions with VF and significant RAMs in our cohort, reflecting the durability of current second-line regimens. Wiley 2021-03 Article PeerReviewed Ross, Jeremy and Jiamsakul, Awachana and Kumarasamy, Nagalingeswaran and Azwa, Raja Iskandar Shah Raja and Merati, Tuti Parwati and Do, Cuong Dat and Lee, Man-Po and Ly, Penh S. and Yunihastuti, Evy and Nguyen, Kinh Van and Ditangco, Rossana and Ng, Oon Tek and Choi, Jun Yong and Oka, S. and Sohn, Annette H and Law, Matthew G. (2021) Virological failure and HIV drug resistance among adults living with HIV on second-line antiretroviral therapy in the Asia-Pacific. HIV Medicine, 22 (3). pp. 201-211. ISSN 1464-2662, DOI https://doi.org/10.1111/hiv.13006 <https://doi.org/10.1111/hiv.13006>. 10.1111/hiv.13006
institution Universiti Malaya
building UM Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider Universiti Malaya
content_source UM Research Repository
url_provider http://eprints.um.edu.my/
topic R Medicine
RB Pathology
Theories of disease. Etiology. Pathogenesis
spellingShingle R Medicine
RB Pathology
Theories of disease. Etiology. Pathogenesis
Ross, Jeremy
Jiamsakul, Awachana
Kumarasamy, Nagalingeswaran
Azwa, Raja Iskandar Shah Raja
Merati, Tuti Parwati
Do, Cuong Dat
Lee, Man-Po
Ly, Penh S.
Yunihastuti, Evy
Nguyen, Kinh Van
Ditangco, Rossana
Ng, Oon Tek
Choi, Jun Yong
Oka, S.
Sohn, Annette H
Law, Matthew G.
Virological failure and HIV drug resistance among adults living with HIV on second-line antiretroviral therapy in the Asia-Pacific
description To assess second-line antiretroviral therapy (ART) virological failure and HIV drug resistance-associated mutations (RAMs), in support of third-line regimen planning in Asia. Methods Adults > 18 years of age on second-line ART for >= 6 months were eligible. Cross-sectional data on HIV viral load (VL) and genotypic resistance testing were collected or testing was conducted between July 2015 and May 2017 at 12 Asia-Pacific sites. Virological failure (VF) was defined as VL > 1000 copies/mL with a second VL > 1000 copies/mL within 3-6 months. FASTA files were submitted to Stanford University HIV Drug Resistance Database and RAMs were compared against the IAS-USA 2019 mutations list. VF risk factors were analysed using logistic regression. Results Of 1378 patients, 74% were male and 70% acquired HIV through heterosexual exposure. At second-line switch, median interquartile range (IQR)] age was 37 (32-42) years and median (IQR) CD4 count was 103 (43.5-229.5) cells/mu L; 93% received regimens with boosted protease inhibitors (PIs). Median duration on second line was 3 years. Among 101 patients (7%) with VF, CD4 count > 200 cells/mu L at switch odds ratio (OR) = 0.36, 95% confidence interval (CI): 0.17-0.77 vs. CD4 <= 50) and HIV exposure through male-male sex (OR = 0.32, 95% CI: 0.17-0.64 vs. heterosexual) or injecting drug use (OR = 0.24, 95% CI: 0.12-0.49) were associated with reduced VF. Of 41 (41%) patients with resistance data, 80% had at least one RAM to nonnucleoside reverse transcriptase inhibitors (NNRTIs), 63% to NRTIs, and 35% to PIs. Of those with PI RAMs, 71% had two or more. Conclusions There were low proportions with VF and significant RAMs in our cohort, reflecting the durability of current second-line regimens.
format Article
author Ross, Jeremy
Jiamsakul, Awachana
Kumarasamy, Nagalingeswaran
Azwa, Raja Iskandar Shah Raja
Merati, Tuti Parwati
Do, Cuong Dat
Lee, Man-Po
Ly, Penh S.
Yunihastuti, Evy
Nguyen, Kinh Van
Ditangco, Rossana
Ng, Oon Tek
Choi, Jun Yong
Oka, S.
Sohn, Annette H
Law, Matthew G.
author_facet Ross, Jeremy
Jiamsakul, Awachana
Kumarasamy, Nagalingeswaran
Azwa, Raja Iskandar Shah Raja
Merati, Tuti Parwati
Do, Cuong Dat
Lee, Man-Po
Ly, Penh S.
Yunihastuti, Evy
Nguyen, Kinh Van
Ditangco, Rossana
Ng, Oon Tek
Choi, Jun Yong
Oka, S.
Sohn, Annette H
Law, Matthew G.
author_sort Ross, Jeremy
title Virological failure and HIV drug resistance among adults living with HIV on second-line antiretroviral therapy in the Asia-Pacific
title_short Virological failure and HIV drug resistance among adults living with HIV on second-line antiretroviral therapy in the Asia-Pacific
title_full Virological failure and HIV drug resistance among adults living with HIV on second-line antiretroviral therapy in the Asia-Pacific
title_fullStr Virological failure and HIV drug resistance among adults living with HIV on second-line antiretroviral therapy in the Asia-Pacific
title_full_unstemmed Virological failure and HIV drug resistance among adults living with HIV on second-line antiretroviral therapy in the Asia-Pacific
title_sort virological failure and hiv drug resistance among adults living with hiv on second-line antiretroviral therapy in the asia-pacific
publisher Wiley
publishDate 2021
url http://eprints.um.edu.my/34654/
_version_ 1744649191774224384
score 13.211869

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