Predictors of Long-Term Viral Failure Among Ugandan Children and Adults Treated With Antiretroviral Therapy

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dc.contributor.authorKamya, Moses R.
dc.contributor.authorMayanja-Kizza, Harriet
dc.contributor.authorKambugu, Andrew
dc.contributor.authorBakeera-Kitaka, Sabrina
dc.contributor.authorSemitala, Fred
dc.contributor.authorMwebaze-Songa, Patricia
dc.contributor.authorCastelnuovo, Barbara
dc.contributor.authorGasasira, Anne F.
dc.contributor.authorKatabira, Elly
dc.contributor.authorKekitiinwa, Adeodata
dc.contributor.authorThomas, David L.
dc.contributor.authorthe Academic Alliance for AIDS Care and Prevention in Africa
dc.date.accessioned2022-05-25T11:01:39Z
dc.date.available2022-05-25T11:01:39Z
dc.date.issued2007
dc.description.abstractHIV RNA viral load testing is costly and is generally unavailable in resource-limited settings. We identified predictors of viral failure and documented genotypic mutations in a subset of patients with viral failure after 12 months on antiretroviral therapy (ART).From April 2004 to June 2005, consecutive treatment-naive patients beginning ART at a university clinic in Uganda were enrolled. Clinical information, CD4 cell count, and HIV RNA level were collected at baseline and every 3 to 6 months. Independent predictors of viral failure were identified using multivariate logistic regression. Genotypic drug resistance for 8 patients with viral failure at 12 months was measured at baseline and at 6 and 12 months.Five hundred twenty-six adults and 250 children (0 to 18 years of age) were started on first-line ART regimens and followed for 12 months. Outcomes could not be assessed in 13% of patients (79 died and 21 were withdrawn). Children were almost twice as likely to have viral failure compared with adults (26% vs. 14%; P = 0.0001). In adults, the sole independent predictor of viral failure was treatment with stavudine (d4T)/lamivudine (3TC)/nevirapine (NVP) versus zidovudine (ZDV)/3TC/efavirenz (EFV) (odds ratio [OR] = 2.59, 95% confidence interval [CI]: 1.20 to 5.59). In children, independent predictors of viral failure included male gender (OR = 2.44, 95% CI: 1.20 to 4.93), baseline CD4% <5 (OR = 2.69, 95% CI: 1.28 to 5.63), and treatment with d4T/3TC/NVP versus ZDV/3TC/EFV (OR = 2.46, 95% CI: 1.23 to 4.90). All 8 patients with viral breakthrough and genotypic drug resistance results had nonnucleoside reverse transcriptase inhibitor (NNRTI)- and 3TC-associated mutations.These data demonstrate the effectiveness of ART in a low-resource setting. Children and patients of all ages taking the d4T/3TC/NVP regimen were more likely to have viral failure. Our data suggest that viral failure occurring 6 months or more after the start of ART regimens commonly used in Uganda is likely to be associated with NNRTI- and 3TC-resistant virus.en_US
dc.identifier.citationKamya, M. R., Mayanja-Kizza, H., Kambugu, A., Bakeera-Kitaka, S., Semitala, F., Mwebaze-Songa, P., ... & Kekitiinwa, A. (2007). Predictors of long-term viral failure among ugandan children and adults treated with antiretroviral therapy. JAIDS Journal of Acquired Immune Deficiency Syndromes, 46(2), 187-193.doi: 10.1097/QAI.0b013e31814278c0en_US
dc.identifier.urihttps://nru.uncst.go.ug/handle/123456789/3324
dc.language.isoenen_US
dc.publisherJAIDS Journal of Acquired Immune Deficiency Syndromesen_US
dc.subjectantiretroviral therapy; predictors; resource-limited settings; viral failureen_US
dc.titlePredictors of Long-Term Viral Failure Among Ugandan Children and Adults Treated With Antiretroviral Therapyen_US
dc.typeArticleen_US
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