Durability Of Non-Nucleotide Reverse Transcriptase Inhibitor-Based First-Line ART Regimens After 7 Years Of Treatment In Rural Uganda
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
Medicine
Abstract
Most antiretroviral therapy (ART) programs in resource-limited settings have historically used non-nucleotide reverse transcriptase inhibitor (NNRTI)-based regimens with limited access to routine viral load (VL) testing. We examined the long-term success of these regimens in rural Uganda among participants with 1 measured suppressed VL. We conducted a prospective cohort study of participants who had been on NNRTI-based first-line regimens for ≥4years and had a VL <1000copies/mL at enrollment in Jinja, Uganda. We collected clinical and behavioral data every 6 months and measured VL again after 3 years. We quantified factors associated with virologic failure (VF) (VL≥1000copies/mL) using Wilcoxon Rank Sum, chisquare,
and Fisher’s Exact Tests. We enrolled 503 participants; 75.9% were female, the median age was 45years, and the median duration of time on ART was 6.8 years (IQR=6.0–7.6 years). Sixty-nine percent of participants were receiving nevirapine, lamivudine, and zidovudine regimens; 22.5% were receiving efavirenz, lamivudine, and zidovudine; and 8.6% were receiving other regimens. Of the 479 with complete follow-up data, 12 (2.5%) had VL≥1000copies/mL. VF was inversely associated with reporting never missing pills (41.7% of VFs vs 72.8% non-VFs, P=.034). There were differences in distribution of the previous ART regimens (P=.005), but no clear associations with specific regimens. There was no association between having a VL of 50 to 999copies/mL at enrollment and later VF (P=.160). Incidence of VF among individuals receiving ART for nearly 7 years was very low in the subsequent 3 years. NNRTI-based regimens appear to be very durable among those with good initial adherence.
Description
Keywords
antiretroviral therapy, drug resistance, non-nucleoside reverse transcriptase inhibitors, sub-Saharan Africa, treatment failure
Citation
Nanfuka, M., Forrest, J. I., Zhang, W., Okoboi, S., Birungi, J., Kaleebu, P., ... & Moore, D. M. (2021). Durability of non-nucleotide reverse transcriptase inhibitor-based first-line ART regimens after 7 years of treatment in rural Uganda: A prospective cohort study. Medicine, 100(19).