Journal
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY
Volume 72, Issue 11, Pages 3141-3148Publisher
OXFORD UNIV PRESS
DOI: 10.1093/jac/dkx252
Keywords
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Funding
- South African Medical Research Council [MRC-RFA-UFSP-01-2013/UKZN HIVEPI]
- Royal Society Newton Advanced Fellowship (TdO)
- European Union's Horizon Research and Innovation Programme [634650]
- Centers for Disease Control and Prevention [1U19GH000571-01]
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Background: KwaZulu-Natal (KZN) Province in South Africa has the highest HIV disease burden in the country, with an estimated population prevalence of 24.7%. A pilot sentinel surveillance project was undertaken in KZN to classify the proportion of adult patients failing first-line ART and to describe the patterns of drug resistance mutations (DRMs) in patients with virological failure (VF). Methods: Cross-sectional surveillance of acquired HIV drug resistance was conducted in 15 sentinel ART clinics between August and November 2013. Two population groups were surveyed: on ART for 12-15 months (Cohort A) or 24-36 months (Cohort B). Plasma specimens with viral load >= 1000 copies/mL were defined as VF and genotyped for DRMs. Results: A total of 1299 adults were included in the analysis. The prevalence of VF was 4.0%(95% CI 1.8-8.8) among 540 adults in Cohort A and 7.7% (95% CI 4.4-13.0) of 759 adults in Cohort B. Treatment with efavirenz was more likely to suppress viral load in Cohort A (P = 0.005). Independent predictors of VF for Cohort B included male gender, advanced WHO stage at ART initiation and treatment with stavudine or zidovudine compared with tenofovir. DRMs were detected in 89% of 123 specimenswith VF, including M184I/V, K103N/S, K65N/R, V106A/M and Y181C. Conclusions: VF in adults in KZN was < 8% up to 3 years post-ART initiation but was associated with a high frequency of DRMs. These data identify key groups for intensified adherence counselling and highlight the need to optimize first-line regimens to maintain viral suppression.
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