Reynolds, Steven JSendagire, HakimNewell, KevinCastelnuovo, BarbaraNankya, ImmaculateKamya, MosesQuinn, Thomas C.Manabe, Yukari C.Kambugu, Andrew2022-03-202022-03-202012Reynolds, S. J., Sendagire, H., Newell, K., Castelnuovo, B., Nankya, I., Kamya, M., ... & Kambugu, A. (2012). Virologic versus immunologic monitoring and the rate of accumulated genotypic resistance to first-line antiretroviral drugs in Uganda. BMC infectious diseases, 12(1), 1-8.https://doi.org/10.1186/1471-2334-12-3811471-2334https://nru.uncst.go.ug/xmlui/handle/123456789/2839Viral load monitoring (VLM) to identify individuals failing antiretroviral therapy (ART) is not widely available in resource-limited settings. We compared the genotypic resistance patterns between clients with VLM versus immunological monitoring (IM).Between 2004–2008, 559 ART naïve clients were enrolled in a prospective cohort, initiated on ART, and monitored with viral load (VL) and CD4+ cell counts every 6 months (VLM group). From February 2008 through June 2009, 998 clients on ART for 36–40 months (corresponding to the follow-up time of the VLM group) at the same clinic and monitored with CD4+ cell counts every 6 months were recruited into a cross sectional study (IM group). Samples from VLM clients at 12, 24 and 36 months and IM clients at 36–40 months with VL > 2000 copies/ml underwent genotypic drug resistance testing.Baseline characteristics were similar. Virologic failure (VL > 400 copies/ml) at 12, 24 and 36 months in the VLM group were 12%, 6% and 8% respectively, and in the IM group 10% at 36–40 months. Samples from 39 VLM and 70 IM clients were genotyped. 23/39 (59%) clients in the VLM group (at 12, 24 or 36 months) compared to 63/70 (90%) in the IM group, (P < 0.0001) had at least 1 non-nucleoside reverse transcriptase mutation. 19/39 (49%) of VLM clients had an M184V mutation compared to 61/70 (87%) in the IM group (P < 0.0001). Only 2/39 (5%) of VLM clients developed thymidine analogue mutations compared to 34/70 (49%) of IM clients (P < 0.0001).Routine VL monitoring reduced the rate of accumulated genotypic resistance to commonly used ART in Uganda.enHIV-1, Antiretroviral therapy, Drug resistanceArticle