High prevalence of PI resistance in patients failing second-line ART in Vietnam
Web of Science
AuthorVu, PT; Vo, MQ; Day, JN; Nguyen, TC; Shikuma, CM; Farrar, J; Nguyen, VVC; Thwaites, GE; Dunstan, SJ; Thuy, L
Source TitleJournal of Antimicrobial Chemotherapy
PublisherOXFORD UNIV PRESS
University of Melbourne Author/sDunstan, Sarah
Document TypeJournal Article
CitationsVu, P. T., Vo, M. Q., Day, J. N., Nguyen, T. C., Shikuma, C. M., Farrar, J., Nguyen, V. V. C., Thwaites, G. E., Dunstan, S. J. & Thuy, L. (2016). High prevalence of PI resistance in patients failing second-line ART in Vietnam. JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, 71 (3), pp.762-774. https://doi.org/10.1093/jac/dkv385.
Access StatusOpen Access
BACKGROUND: There are limited data from resource-limited settings on antiretroviral resistance mutations that develop in patients failing second-line PI ART. METHODS: We performed a cross-sectional virological assessment of adults on second-line ART for ≥6 months between November 2006 and December 2011, followed by a prospective follow-up over 2 years of patients with virological failure (VF) at the Hospital for Tropical Diseases, Vietnam. VF was defined as HIV RNA concentrations ≥1000 copies/mL. Resistance mutations were identified by population sequencing of the pol gene and interpreted using the 2014 IAS-USA mutation list and the Stanford algorithm. Logistic regression modelling was performed to identify predictors of VF. RESULTS: Two hundred and thirty-one patients were enrolled in the study. The median age was 32 years; 81.0% were male, 95.7% were on a lopinavir/ritonavir-containing regimen and 22 (9.5%) patients had VF. Of the patients with VF, 14 (64%) carried at least one major protease mutation [median: 2 (IQR: 1-3)]; 13 (59%) had multiple protease mutations conferring intermediate- to high-level resistance to lopinavir/ritonavir. Mutations conferring cross-resistance to etravirine, rilpivirine, tipranavir and darunavir were identified in 55%, 55%, 45% and 27% of patients, respectively. Higher viral load, adherence <95% and previous indinavir use were independent predictors of VF. The 2 year outcomes of the patients maintained on lopinavir/ritonavir included: death, 7 (35%); worsening virological/immunological control, 6 (30%); and virological re-suppression, 5 (25%). Two patients were switched to raltegravir and darunavir/ritonavir with good HIV control. CONCLUSIONS: High-prevalence PI resistance was associated with previous indinavir exposure. Darunavir plus an integrase inhibitor and lamivudine might be a promising third-line regimen in Vietnam.
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