Browsing by Author "Ameni, Gobena"

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    Genetic Diversity and Acquired Drug Resistance Mutations Detected by Deep Sequencing in Virologic Failures among Antiretroviral Treatment Experienced Human Immunodeficiency Virus-1 Patients in a Pastoralist Region of Ethiopia
    (Infection and Drug Resistance, 2021) Tachbele, Erdaw; Kyobe, Samuel; Ashaba Katabazi, Fred; Kigozi, Edgar; Mwesigwa, Savannah; Joloba, Moses; Messele, Alebachew; Amogne, Wondwossen; Legesse, Mengistu; Pieper, Rembert; Ameni, Gobena
    This study was conducted to investigate the drug resistance mutations and genetic diversity of HIV-1 in ART experienced patients in South Omo, Ethiopia. Patients and Methods: A cross-sectional study conducted on 253 adult patients attending ART clinics for ≥6 months in South Omo. Samples with VL ≥1000 copies/ mL were considered as virological failures (VF) and their reverse transcriptase gene codons 90–234 were sequenced using Illumina MiSeq. MinVar was used for the identification of the subtypes and drug resistance mutations. Phylogenetic tree was constructed by neighbor-joining method using the maximum likelihood model. Results: The median duration of ART was 51 months and 18.6% (47/253) of the patients exhibited VF. Of 47 viraemic patients, the genome of 41 were sequenced and subtype C was dominant (87.8%) followed by recombinant subtype BC (4.9%), M-09- CPX (4.9) and BF1 (2.4%). Of 41 genotyped subjects, 85.4% (35/41) had at least one ADR mutation. Eighty-one percent (33/41) of viraemic patients harbored NRTI resistance mutations, and 48.8% (20/41) were positive for NNRTI resistance mutations, with 43.9% dual resistance mutations. Among NRTI resistance mutations, M184V (73.2%), K219Q (63.4%) and T215 (56.1%) complex were the most mutated positions, while the most common NNRTI resistance mutations were K103N (24.4%), K101E, P225H and V108I 7.5% each. Active tuberculosis (aOR=13, 95% CI= 3.46–29.69), immunological failure (aOR=3.61, 95% CI=1.26–10.39), opportunistic infections (aOR=8.39, 95% CI= 1.75–40.19), and poor adherence were significantly associated with virological failure, while rural residence (aOR 2.37; 95% CI: 1.62–9.10, P= 0.05), immunological failures (aOR 2.37; 95% CI: 1.62–9.10, P= 0.05) and high viral load (aOR 16; 95% CI: 5.35 51.59, P <0.001) were predictors of ADR mutation among the ART experienced and viraemic study subjects. Conclusion: The study revealed considerable prevalence of VF and ADR mutation with the associated risk indicators. Regular virological monitoring and drug resistance genotyping methods should be implemented for better ART treatment outcomes of the nation.
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    Prevalence and determinants of virological failure among adult antiretroviral treatment experienced HIV-1 patients in South Omo, Ethiopia
    (Ethiopian Journal of Health Development, 2022) Tachbele, Erdaw; Kyobe, Samuel; Ashaba, Fred; Kigozi, Edgar; Mwesigwa, Savannah; Joloba, Moses; Amogne, Wondwossen; Legesse, Mengistu; Peiper, Rembert; Ameni, Gobena
    Virological failure (VF) is a challenge which hinders the success of the antiretroviral treatment (ART) program. Although viral load is the preferred method used to detect and confirm treatment failure, research into its prevalence and determinants is limited. Objective: This study was conducted to determine the prevalence of virological failure and its determinants among HIV-1 infected adults, who experienced first line ART in South Omo, Ethiopia. Methods: A cross-sectional study was conducted on patients attending ART clinics at Jinka Zonal hospital and four rural health centers found in South Omo. A total of 253 adult patients who were on ART for ≥ 6 months were recruited sequentially from January 2015- December 2016. In addition to the socio-demographic and clinical data, 10 ml of blood was collected for the CD4+ T cell count and the viral load measurements. CD4+T cell count was conducted using the FACS Caliber flow cytometer and the viral load was estimated using a quantitative real time reverse transcriptase polymerase chain reaction (qRT-PCR). Samples with a VL ≥1000 copies/mL were considered as virological failure. Logistic regression analysis was used to identify correlates of virological failure. Results: The median duration of ART was 51 months. About 61% of the participants were females with a mean age of 33.5 years. Majority of the participants (70%) were taking the tenofovir (TDF) based ART, while 30% were taking a zidovudine (AZT) based regimen. Majority (71.9%) of the participants started ART in WHO III/IV stage, with a median base line CD4 count of 239 cell/μL. More than 40% of the participants reported poor ART adherence, and 11% had immunological failure. From a total of 253 patients, 206(81.4 %) [95%CI: 76.7-86.2] had viral suppression, while 47 (18.6%) [95%CI: 13.8-23.3] had virological failure with a mean viral load of 185,506 copies/mL (95%CI: 39083-408100). None of the virological failures were switched to second line ART. According to the multivariate logistic analysis, active tuberculosis (aOR=13, 95% CI= 3.46-29.69), immunological failure (aOR=3.61, 95% CI=1.26-10.39), opportunistic infections (aOR=8.39, 95% CI= 1.75-40.19), and poor adherence were significantly associated with VF among the study participants. Conclusion: The study revealed a considerable prevalence of virological failures with the associated risk indicators. Based on the results and the difficulty faced, of being unable to place patients who were treatment resistant in second line ART, indicates that immunological and clinical criteria are poor biomarkers of drug switching. Hence, regular virological monitoring should be implemented for better ART treatment outcomes in individuals who are HIV positive.