A Retrospective Survey of HIV Drug Resistance Among Patients 1 Year After Initiation of Antiretroviral Therapy at 4 Clinics in Malawi

• Published in: Clinical infectious diseases Vol. 54; no. suppl_4; pp. S355 - S361
• Main Authors: Wadonda-Kabondo, Nellie, Hedt, Bethany L., van Oosterhout, Joep J., Moyo, Kundai, Limbambala, Eddie, Bello, George, Chilima, Ben, Schouten, Erik, Harries, Anthony, Massaquoi, Moses, Porter, Carol, Weigel, Ralf, Hosseinipour, Mina, Aberle-Grasse, John, Jordan, Michael R., Kabuluzi, Storn, Bennett, Diane E.
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 15.05.2012
• Subjects: Adult; AIDS; Anti-Retroviral Agents - pharmacology; Anti-Retroviral Agents - therapeutic use; Antiretroviral drugs; Antiretrovirals; Art therapy; Drug resistance; Drug Resistance, Viral; Female; Health outcomes; HIV; HIV - drug effects; HIV - genetics; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Infections - virology; Human immunodeficiency virus; Humans; Lost to follow up; Malawi - epidemiology; Male; Medical treatment; Middle Aged; Population Surveillance; Retrospective Studies; Specimens; Supplement; Treatment Outcome; Viral Load; Virology; World Health Organization; Malawi
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/cis004

In 2004, Malawi began scaling up its national antiretroviral therapy (ART) program. Because of limited treatment options, population-level surveillance of acquired human immunodeficiency virus drug resistance (HIVDR) is critical to ensuring long-term treatment success. The World Health Organization target for clinic-level HIVDR prevention at 12 months after ART initiation is ≥70%. In 2007, viral load and HIVDR genotyping was performed in a retrospective cohort of 596 patients at 4 ART clinics. Overall, HIVDR prevention (using viral load ≤400 copies/mL) was 72% (95% confidence interval [CI], 67%—77%; range by site, 60%—83%) and detected HIVDR was 3.4% (95% CI, 1.8%—5.8%; range by site, 2.5%—4.7%). Results demonstrate virological suppression and HIVDR consistent with previous reports from sub-Saharan Africa. High rates of attrition because of loss to follow-up were noted and merit attention.