Previous antiretroviral drug use compromises standard first-line HIV therapy and is mediated through drug-resistance

Abstract In ART programs in sub-Saharan Africa, a growing proportion of HIV-infected persons initiating first-line antiretroviral therapy (ART) have a history of prior antiretroviral drug use (PAU). We assessed the effect of PAU on the risk of pre-treatment drug resistance (PDR) and virological fail...

Descripción completa

Guardado en:
Detalles Bibliográficos
Autores principales: Seth C. Inzaule, Cissy M. Kityo, Margaret Siwale, Alani Sulaimon Akanmu, Maureen Wellington, Marleen de Jager, Prudence Ive, Kishor Mandaliya, Wendy Stevens, T. Sonia Boender, Pascale Ondoa, Kim C. E. Sigaloff, Denise Naniche, Tobias F. Rinke de Wit, Raph L. Hamers
Formato: article
Lenguaje:EN
Publicado: Nature Portfolio 2018
Materias:
R
Q
Acceso en línea:https://doaj.org/article/0647a6dbb601463f9750fafd510d38ea
Etiquetas: Agregar Etiqueta
Sin Etiquetas, Sea el primero en etiquetar este registro!
id oai:doaj.org-article:0647a6dbb601463f9750fafd510d38ea
record_format dspace
spelling oai:doaj.org-article:0647a6dbb601463f9750fafd510d38ea2021-12-02T15:09:07ZPrevious antiretroviral drug use compromises standard first-line HIV therapy and is mediated through drug-resistance10.1038/s41598-018-33538-02045-2322https://doaj.org/article/0647a6dbb601463f9750fafd510d38ea2018-10-01T00:00:00Zhttps://doi.org/10.1038/s41598-018-33538-0https://doaj.org/toc/2045-2322Abstract In ART programs in sub-Saharan Africa, a growing proportion of HIV-infected persons initiating first-line antiretroviral therapy (ART) have a history of prior antiretroviral drug use (PAU). We assessed the effect of PAU on the risk of pre-treatment drug resistance (PDR) and virological failure (VF) in a multicountry cohort of HIV-infected adults initiated on a standard non-nucleoside reverse transcriptase inhibitor (NNRTI)-based first-line ART. Multivariate logistic regression was used to assess the associations between PAU, PDR and VF (defined as viral load ≥400 cps/mL). Causal mediation analysis was used to assess the proportion of the effect of PAU on VF that could be eliminated by intervening on PDR. Of 2737 participants, 122 (4.5%) had a history of PAU. Participants with PAU had a 7.2-fold (95% CI 4.4–11.7) risk of carrying PDR and a 3.1-fold (95% CI 1.6–6.1) increased risk of VF, compared to antiretroviral-naïve participants. Controlling for PDR would eliminate nearly half the effect of PAU on the risk of VF. Patients with a history of PAU are at increased risk of ART failure, which is to a large extent attributable to PDR. These findings support the recent WHO recommendations for use of differentiated, non-NNRTI-based empiric first-line therapy in patients with PAU.Seth C. InzauleCissy M. KityoMargaret SiwaleAlani Sulaimon AkanmuMaureen WellingtonMarleen de JagerPrudence IveKishor MandaliyaWendy StevensT. Sonia BoenderPascale OndoaKim C. E. SigaloffDenise NanicheTobias F. Rinke de WitRaph L. HamersNature PortfolioarticleCausal Mediation AnalysisFirst-line Empirical TherapyNon-nucleoside Reverse Transcriptase Inhibitors (NNRTI)Virological Failure (VF)Prevention Of Mother-to-child Transmission (PMTCT)MedicineRScienceQENScientific Reports, Vol 8, Iss 1, Pp 1-7 (2018)
institution DOAJ
collection DOAJ
language EN
topic Causal Mediation Analysis
First-line Empirical Therapy
Non-nucleoside Reverse Transcriptase Inhibitors (NNRTI)
Virological Failure (VF)
Prevention Of Mother-to-child Transmission (PMTCT)
Medicine
R
Science
Q
spellingShingle Causal Mediation Analysis
First-line Empirical Therapy
Non-nucleoside Reverse Transcriptase Inhibitors (NNRTI)
Virological Failure (VF)
Prevention Of Mother-to-child Transmission (PMTCT)
Medicine
R
Science
Q
Seth C. Inzaule
Cissy M. Kityo
Margaret Siwale
Alani Sulaimon Akanmu
Maureen Wellington
Marleen de Jager
Prudence Ive
Kishor Mandaliya
Wendy Stevens
T. Sonia Boender
Pascale Ondoa
Kim C. E. Sigaloff
Denise Naniche
Tobias F. Rinke de Wit
Raph L. Hamers
Previous antiretroviral drug use compromises standard first-line HIV therapy and is mediated through drug-resistance
description Abstract In ART programs in sub-Saharan Africa, a growing proportion of HIV-infected persons initiating first-line antiretroviral therapy (ART) have a history of prior antiretroviral drug use (PAU). We assessed the effect of PAU on the risk of pre-treatment drug resistance (PDR) and virological failure (VF) in a multicountry cohort of HIV-infected adults initiated on a standard non-nucleoside reverse transcriptase inhibitor (NNRTI)-based first-line ART. Multivariate logistic regression was used to assess the associations between PAU, PDR and VF (defined as viral load ≥400 cps/mL). Causal mediation analysis was used to assess the proportion of the effect of PAU on VF that could be eliminated by intervening on PDR. Of 2737 participants, 122 (4.5%) had a history of PAU. Participants with PAU had a 7.2-fold (95% CI 4.4–11.7) risk of carrying PDR and a 3.1-fold (95% CI 1.6–6.1) increased risk of VF, compared to antiretroviral-naïve participants. Controlling for PDR would eliminate nearly half the effect of PAU on the risk of VF. Patients with a history of PAU are at increased risk of ART failure, which is to a large extent attributable to PDR. These findings support the recent WHO recommendations for use of differentiated, non-NNRTI-based empiric first-line therapy in patients with PAU.
format article
author Seth C. Inzaule
Cissy M. Kityo
Margaret Siwale
Alani Sulaimon Akanmu
Maureen Wellington
Marleen de Jager
Prudence Ive
Kishor Mandaliya
Wendy Stevens
T. Sonia Boender
Pascale Ondoa
Kim C. E. Sigaloff
Denise Naniche
Tobias F. Rinke de Wit
Raph L. Hamers
author_facet Seth C. Inzaule
Cissy M. Kityo
Margaret Siwale
Alani Sulaimon Akanmu
Maureen Wellington
Marleen de Jager
Prudence Ive
Kishor Mandaliya
Wendy Stevens
T. Sonia Boender
Pascale Ondoa
Kim C. E. Sigaloff
Denise Naniche
Tobias F. Rinke de Wit
Raph L. Hamers
author_sort Seth C. Inzaule
title Previous antiretroviral drug use compromises standard first-line HIV therapy and is mediated through drug-resistance
title_short Previous antiretroviral drug use compromises standard first-line HIV therapy and is mediated through drug-resistance
title_full Previous antiretroviral drug use compromises standard first-line HIV therapy and is mediated through drug-resistance
title_fullStr Previous antiretroviral drug use compromises standard first-line HIV therapy and is mediated through drug-resistance
title_full_unstemmed Previous antiretroviral drug use compromises standard first-line HIV therapy and is mediated through drug-resistance
title_sort previous antiretroviral drug use compromises standard first-line hiv therapy and is mediated through drug-resistance
publisher Nature Portfolio
publishDate 2018
url https://doaj.org/article/0647a6dbb601463f9750fafd510d38ea
work_keys_str_mv AT sethcinzaule previousantiretroviraldrugusecompromisesstandardfirstlinehivtherapyandismediatedthroughdrugresistance
AT cissymkityo previousantiretroviraldrugusecompromisesstandardfirstlinehivtherapyandismediatedthroughdrugresistance
AT margaretsiwale previousantiretroviraldrugusecompromisesstandardfirstlinehivtherapyandismediatedthroughdrugresistance
AT alanisulaimonakanmu previousantiretroviraldrugusecompromisesstandardfirstlinehivtherapyandismediatedthroughdrugresistance
AT maureenwellington previousantiretroviraldrugusecompromisesstandardfirstlinehivtherapyandismediatedthroughdrugresistance
AT marleendejager previousantiretroviraldrugusecompromisesstandardfirstlinehivtherapyandismediatedthroughdrugresistance
AT prudenceive previousantiretroviraldrugusecompromisesstandardfirstlinehivtherapyandismediatedthroughdrugresistance
AT kishormandaliya previousantiretroviraldrugusecompromisesstandardfirstlinehivtherapyandismediatedthroughdrugresistance
AT wendystevens previousantiretroviraldrugusecompromisesstandardfirstlinehivtherapyandismediatedthroughdrugresistance
AT tsoniaboender previousantiretroviraldrugusecompromisesstandardfirstlinehivtherapyandismediatedthroughdrugresistance
AT pascaleondoa previousantiretroviraldrugusecompromisesstandardfirstlinehivtherapyandismediatedthroughdrugresistance
AT kimcesigaloff previousantiretroviraldrugusecompromisesstandardfirstlinehivtherapyandismediatedthroughdrugresistance
AT denisenaniche previousantiretroviraldrugusecompromisesstandardfirstlinehivtherapyandismediatedthroughdrugresistance
AT tobiasfrinkedewit previousantiretroviraldrugusecompromisesstandardfirstlinehivtherapyandismediatedthroughdrugresistance
AT raphlhamers previousantiretroviraldrugusecompromisesstandardfirstlinehivtherapyandismediatedthroughdrugresistance
_version_ 1718387856002514944