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Virological failure and drug resistance during first line anti‐retroviral treatment in Indonesia
Author(s) -
Fibriani Azzania,
Wisaksana Rudi,
Indrati Agnes,
Hartantri Yovita,
van de Vijver David,
Schutten Martin,
Alisjahbana Bachti,
Sudjana Primal,
Boucher Charles A.B.,
van Crevel Reinout,
van der Ven Andre
Publication year - 2013
Publication title -
journal of medical virology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.782
H-Index - 121
eISSN - 1096-9071
pISSN - 0146-6615
DOI - 10.1002/jmv.23606
Subject(s) - virology , drug resistance , drug , medicine , second line , antiretroviral medication , drug holiday , human immunodeficiency virus (hiv) , biology , first line , viral load , pharmacology , antiretroviral therapy , genetics
The virological response and development of drug resistance during first‐line anti‐retroviral treatment (ART) were studied in Indonesia where the majority of patients infected with HIV have a history of injecting drug use, which is often linked with lower treatment adherence and development of drug‐resistance. As many as 575 patients starting ART between September 2007 and March 2010 in Hasan Sadikin Hospital Bandung were followed prospectively. Clinical and laboratory monitoring was performed every 6 months. Plasma samples with HIV‐RNA ≥400 copies/ml were examined for drug resistance mutations. Most patients were male (72.3%), 59.7% had a history of injecting drug use, and the median CD4+ cells count before start of ART was 35 cells/mm 3 (IQR 10–104). From 438 HIV patients with HIV‐RNA measurements, 40 (9.1%) subjects had HIV‐RNA ≥400 copies/ml after 24 weeks (median follow‐up 16 (IQR 8–25) months). Of these failing patients 16 (47%) subjects had drug resistance mutations, predominantly M184V (35.3%), Y181C (23.5%), K103N (11.7%), and TAMs (11.7%). A history of treatment discontinuation ≥1 month, reported by 5.3% (23) of patients, was strongly associated with virological failure (adjusted OR 12.64, 95% CI 4.51–35.41); and a history of injecting drug use was not (OR 0.75, 95% CI 0.38–1.46). This is the largest and most systematic evaluation of virological response to first line ART in Indonesia. Patients in this cohort responded well to first line ART, with low rates of virological failure and drug resistance. A history of injecting drug use should not be a reason to withhold ART in this setting. J. Med. Virol. 85:1394–1401, 2013 . © 2013 Wiley Periodicals, Inc.