Drug resistance outcomes of long-term ART with tenofovir disoproxil fumarate in the absence of virological monitoring

Villa, Giovanni ORCID: 0000-0001-6747-9851, Phillips, Richard O, Smith, Colette, Stockdale, Alexander J ORCID: 0000-0002-5828-3328, Ruggiero, Alessandra, Beloukas, Apostolos ORCID: 0000-0001-5639-0528, Appiah, Lambert T, Chadwick, David, Sarfo, Fred S and Geretti, Anna Maria ORCID: 0000-0002-3670-6588
(2018) Drug resistance outcomes of long-term ART with tenofovir disoproxil fumarate in the absence of virological monitoring. JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, 73 (11). pp. 3148-3157.

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<h4>Objectives</h4>The resistance profiles of patients receiving long-term ART in sub-Saharan Africa have been poorly described. This study obtained a sensitive assessment of the resistance patterns associated with long-term tenofovir-based ART in a programmatic setting where virological monitoring is yet to become part of routine care.<h4>Methods</h4>We studied subjects who, after a median of 4.2 years of ART, replaced zidovudine or stavudine with tenofovir disoproxil fumarate while continuing lamivudine and an NNRTI. Using deep sequencing, resistance-associated mutations (RAMs) were detected in stored samples collected at tenofovir introduction (T0) and after a median of 4.0 years (T1).<h4>Results</h4>At T0, 19/87 (21.8%) subjects showed a detectable viral load and 8/87 (9.2%) had one or more major NNRTI RAMs, whereas 82/87 (94.3%) retained full tenofovir susceptibility. At T1, 79/87 (90.8%) subjects remained on NNRTI-based ART, 5/87 (5.7%) had introduced lopinavir/ritonavir due to immunological failure, and 3/87 (3.4%) had interrupted ART. Whilst 68/87 (78.2%) subjects maintained or achieved virological suppression between T0 and T1, a detectable viral load with NNRTI RAMs at T0 predicted lack of virological suppression at T1. Each treatment interruption, usually reflecting unavailability of the dispensary, doubled the risk of T1 viraemia. Tenofovir, lamivudine and efavirenz selected for K65R, K70E/T, L74I/V and Y115F, alongside M184V and multiple NNRTI RAMs; this resistance profile was accompanied by high viral loads and low CD4 cell counts.<h4>Conclusions</h4>Viraemia on tenofovir, lamivudine and efavirenz led to complex resistance patterns with implications for continued drug activity and risk of onward transmission.

Item Type: Article
Uncontrolled Keywords: Humans, HIV-1, Viremia, HIV Infections, Alkynes, Cyclopropanes, Benzoxazines, Lamivudine, Reverse Transcriptase Inhibitors, Anti-HIV Agents, Treatment Outcome, Antiretroviral Therapy, Highly Active, Viral Load, Drug Resistance, Viral, Mutation, Time Factors, Adult, Africa South of the Sahara, Female, Male, Tenofovir
Depositing User: Symplectic Admin
Date Deposited: 14 Sep 2018 09:17
Last Modified: 19 Jan 2023 01:17
DOI: 10.1093/jac/dky281
Open Access URL: https://academic.oup.com/jac/advance-article/doi/1...
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URI: https://livrepository.liverpool.ac.uk/id/eprint/3026218