Transcript HIV-1 Drug Resistance Pattern Among Patients Suspected of Failing

HIV-1 Drug Resistance Pattern Among
Patients Suspected of Failing 2nd Line
Antiretroviral Therapy in Namibia
Souleymane Sawadogo, Andreas Shiningavamwe, Drew Baughman, Taffa
Negussie, Gram Mutandi, Chunfu Yang, Ndapewa Hamunime, Simon
Agolory
Background
• HIV-infected patients on antiretroviral therapy (ART) are at increased
risk of emergence of drug resistance and virologic failure (VF) due to
the lifelong nature of ART, continuous drug pressure on HIV virus, and
the associated treatment adherence challenges.
• The cost of antiretroviral drugs dramatically increases with change of
ART regimen from 1st-line to 2nd or 3rd-line and hence necessitating
the need for careful monitoring of HIV drug resistance mutations
(HIVDRM).
• Namibia has been conducting limited resistance testing in the public
sector for patients suspected of failing 2nd-line ART since 2007. Here
we report the results of retrospective HIVDR analyses.
Methods
• We conducted a retrospective review of all genotyping laboratory
reports for patients on ART between 2010 and 2015, suspected of
failing 2nd-line regimen.
• Patients’ age, sex and HIVDR genotyping results were abstracted from
the Laboratory database.
• Data were analysed for HIVDR mutations, subtypes and any
associations by gender and age.
Results (1)
• 898 patients results reviewed,
• 420 patients 51% female; median age 38 [IQR 28; 45] had genotyping results.
• Of whom 341 (82%) harbored any HIVDR mutations.
• HIV-1 Subtype C was the most dominant (90%),
• B/C (5%) ,
• 08_BC/C
• CRF02_AG 3% each.
• There was no association between age (p=0.65, RR=1.04, 95% CI=0.88-1.22)
or sex (p=0.17, RR=0.94, 95% CI=0.85-1.03) with HIVDR.
Results (2) Genotyping requests 2010-2015
Results (3)HIV DR major mutations
Results (4) Mutations profile
80%
75%
70%
63%
60%
55%
% with mutation
50%
40%
30%
23%
19%
20%
10%
0%
NNRTI
NRTI
PI
Drugs Class
NNRTI+NRTI
NNRTI+NRTI+PI
Results (5)Mutations by Drug Class over years
Results (6): Major mutation over time
Conclusion &recommendations
• High prevalence of HIVDR among patients suspected of failing 2nd-line.
• Genotyping is needed to guide selection of appropriate ARVS for 3rd-line
regimens.
• This highlights the need for routine monitoring and surveillance of HIVDRM.
• Additional studies are needed to develop standardize 3rd-line regimen for
Namibia.