Seventh International Congress on Drug Therapy in HIV Infection Glasgow, UK - 14-17 November 2004

Int Cong Drug Therapy HIV 2004 Nov 14-18;7:Abstract No. PL4.4

M.R. Kamya¹, L.A. Spacek², H.M. Shihab³, D. Mwesigire³, A. Ronald³, H. Mayanja¹, R.D. Moore², T.C. Quinn^2
1Makerere University, Kampala, Uganda; ²Johns Hopkins Medical Institutions, Baltimore;
³Academic Alliance for AIDS Care and Prevention, Uganda, Kampala;
⁴National Institute of Allergy and Infectious Diseases, Bethesda, USA

To evaluate response to antiretroviral therapy (ART) in Kampala, Uganda.

We conducted a cross-sectional study of 137 HIV-infected patients on ART at Mulago Hospital Infectious Diseases Clinic. We measured prevalence of viral suppression, evaluated predictors of response to ART and documented phenotypic resistance patterns and genotypic mutations.

91 (66%) participants had undetectable viral load after a median 38 weeks of ART. 91% were treated with non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens. Independent predictors of virologic suppression were treatment with first anti-retroviral regimen (OR 3.3, 95%CI 1.5-7.3) and treatment for <1 year (OR 2.2, 95%CI 1.1-4.7). Unplanned treatment interruption (OR 0.2, 95%CI 0.1-0.5) and sub-standard regimens (OR 0.2, 95%CI 0.1-1.0) predicted virologic failure. Of 36 with resistance testing results, 44% were HIV-1 subtype A, 42% subtype D, 8% A/D recombinant and 6% A/E recombinant. In 27 of 124 treated with NNRTIs, the primary mutation was K103N. Resistance to nucleoside reverse transcriptase inhibitors was predominantly M184V.

Majority experienced viral suppression and clinical benefit. Due to frequent use of NNRTI-based therapy and a low genetic barrier to resistance, resistance was mainly against this drug class. Assessment of virologic response with HIV viral load is needed to mitigate development of resistance. In resource limited settings, initiation of therapy with a potent, durable regimen and uninterrupted supply of medications will optimize the likelihood of viral suppression.

SESSION 4: RESOURCE-POOR SETTINGS [IAS SESSION]

2004-11-14
PL4.4

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