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Virological efficacy with first‐line antiretroviral treatment in India: predictors of viral failure and evidence of viral resuppression
Author(s) -
Shet Anita,
Neogi Ujjwal,
Kumarasamy N.,
DeCosta Ayesha,
Shastri Suresh,
Rewari Bharat Bhushan
Publication year - 2015
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.12563
Subject(s) - medicine , viral load , zidovudine , stavudine , tolerability , cumulative incidence , antiretroviral therapy , human immunodeficiency virus (hiv) , immunology , adverse effect , viral disease , cohort
Objective Combination antiretroviral therapy ( ART ) has improved in efficacy, durability and tolerability. Virological efficacy studies in India are limited. We determined incidence and predictors of virological failure among patients initiating first‐line ART and described virological resuppression after confirmed failure, with the goal of informing national policy. Methods Therapy‐naïve patients initiated on first‐line ART as per national guidelines were monitored every 3 months for adherence and virological response over 2 years. Genotyping on baseline samples was performed to assess primary drug resistance. Multivariate Cox regression analysis was used to assess predictors of virological failure. Results Virological failure rate among 599 eligible patients was 10.7 failures per 100 person‐years. Cumulative failure incidence was 13.2% in the first year and 16.5% over 2 years. Patients initiated on tenofovir had a significantly lower rate of virological failure than those on stavudine or zidovudine (6.7 vs . 11.9 failures per 100 person‐years, P = 0.013). Virological failure was independently associated with age <40 years, mean adherence <95%, non‐tenofovir‐containing regimens and presence of primary drug resistance. In a subset of 311 patients who were reassessed after treatment failure, 19% (11/58) patients resuppressed their viral load to <400 copies/ml after confirmed virological failure. Conclusions Our results support the inclusion of tenofovir as first‐line ART in resource‐limited settings and a role for regular adherence counselling and virological monitoring for enhanced treatment success. Detection of early virological failure should provide an opportunity to augment adherence counselling and repeat viral load testing before therapy switch is considered.