Abstract
Background: Emerging HIV drug resistance (HIVDR) poses a growing threat to the long-term success and durability of highly active antiretroviral therapy (HAART).
Objective: To understand the development of HIVDR and estimate the proportion of potential HIVDR and its associated risk factors among the patients on HAART for one year.
Methods: Antiretroviral-naive patients ≥18 years old were invited to participate in this one-year prospective study from seven clinics in Yunnan, Guangxi, and Xinjiang provinces. A questionnaire and blood draw were collected at baseline and 12 month follow-up. The protocol used was modified slightly from the WHO Protocol for Surveys of HIV Drug Resistance Emerging During Treatment and Related Program Factors in Sentinel ART Sites in Resource-limited Settings.
Results: 435 patients were included in the study, of whom 351 (80.7%) were retained at 12 months. The median baseline CD4 cell count of 351 patients retained at 12 months was 132 cells/mm3, which increased to 305 cells/mm3 at 12 months (P < 0.0001), with those from Yunnan and Guangxi receiving d4T/3TC/NVP and Xinjiang receiving AZT/3TC/NVP. Of the total 435 subjects, 417 met the WHO guideline for classification of outcomes based on endpoints, of whom 310 (75.3%) had a viral load < 1000 copies/ml at 12 months (HIVDR prevention), 17 (4.1%) had a viral load ≥ 1000 copies/ml at 12 months and at least one resistance mutation identified, and 90 (21.6%) were classified as potential HIVDR, including 24 with viral loads≥1000 copies/ml at 12 months but no drug resistance mutations, 42 who were lost to followup, and 24 who had discontinued ART by 12 months. In a logistic regression analysis, patients who self-reported missing doses in the previous month were 8.0 fold (95% CI 3.1-20.9) more likely to develop virologic failure than those who did not. and those from Xinjiang were 12.6 fold (95% CI 5.3-29.8) more likely to fail compared to those from Yunnan and Guangxi. Patients with baseline viral load > 100000 were 3.2 fold (95% CI 1.4-6.9) more likely to fail than those whose baseline viral load≤100000. Why Xinjiang was associated with virologic failure was not clear but may be related to the demographics of the participants from Xinjiang, being significantly more IDUs, poorer, and less adherent than those from Yunnan and Guangxi.
Conclusions: Although successful virologic outcomes were seen in the vast majority (75.3%) of those treated at one year, virologic failure continues to be a problem particularly among those less adherent and from Xinjiang. Additional data are needed to understand the generalizability of these results, particularly those related to Xinjiang. For IDUs, enhancing adherence to HAART and considering the treatment of drug addiction as an integral part of the treatment for HIV infection should be considered. As Chinas National Free Antiretroviral Treatment Program continues to mature and improve, ramping up treatment in these settings may be important considerations to the long-term success of the program.
Keywords: Antiretroviral therapy, HIV drug resistance, HIV drug resistance prevention, HIV RNA, China, HAART, NFATP, HIVDR, mutations, Sentinel ART Sites
Current HIV Research
Title: Factors Associated with HIV Virologic Failure Among Patients on HAART for One Year at Three Sentinel Surveillance Sites in China
Volume: 9 Issue: 2
Author(s): Jingyun Li, Yiming Shao, Yuhua Ruan, Ray Y. Chen, Hui Xing, Lingjie Liao, Wei Zheng, Ping Zhong, Laiyi Kang, Xia Wang, Hong Shang, Shaomin Yang, Yonghui Dong, Wei Liu, Shujia Liang, La Zuo, Huiqin Li and Liting Yang
Affiliation:
Keywords: Antiretroviral therapy, HIV drug resistance, HIV drug resistance prevention, HIV RNA, China, HAART, NFATP, HIVDR, mutations, Sentinel ART Sites
Abstract: Background: Emerging HIV drug resistance (HIVDR) poses a growing threat to the long-term success and durability of highly active antiretroviral therapy (HAART).
Objective: To understand the development of HIVDR and estimate the proportion of potential HIVDR and its associated risk factors among the patients on HAART for one year.
Methods: Antiretroviral-naive patients ≥18 years old were invited to participate in this one-year prospective study from seven clinics in Yunnan, Guangxi, and Xinjiang provinces. A questionnaire and blood draw were collected at baseline and 12 month follow-up. The protocol used was modified slightly from the WHO Protocol for Surveys of HIV Drug Resistance Emerging During Treatment and Related Program Factors in Sentinel ART Sites in Resource-limited Settings.
Results: 435 patients were included in the study, of whom 351 (80.7%) were retained at 12 months. The median baseline CD4 cell count of 351 patients retained at 12 months was 132 cells/mm3, which increased to 305 cells/mm3 at 12 months (P < 0.0001), with those from Yunnan and Guangxi receiving d4T/3TC/NVP and Xinjiang receiving AZT/3TC/NVP. Of the total 435 subjects, 417 met the WHO guideline for classification of outcomes based on endpoints, of whom 310 (75.3%) had a viral load < 1000 copies/ml at 12 months (HIVDR prevention), 17 (4.1%) had a viral load ≥ 1000 copies/ml at 12 months and at least one resistance mutation identified, and 90 (21.6%) were classified as potential HIVDR, including 24 with viral loads≥1000 copies/ml at 12 months but no drug resistance mutations, 42 who were lost to followup, and 24 who had discontinued ART by 12 months. In a logistic regression analysis, patients who self-reported missing doses in the previous month were 8.0 fold (95% CI 3.1-20.9) more likely to develop virologic failure than those who did not. and those from Xinjiang were 12.6 fold (95% CI 5.3-29.8) more likely to fail compared to those from Yunnan and Guangxi. Patients with baseline viral load > 100000 were 3.2 fold (95% CI 1.4-6.9) more likely to fail than those whose baseline viral load≤100000. Why Xinjiang was associated with virologic failure was not clear but may be related to the demographics of the participants from Xinjiang, being significantly more IDUs, poorer, and less adherent than those from Yunnan and Guangxi.
Conclusions: Although successful virologic outcomes were seen in the vast majority (75.3%) of those treated at one year, virologic failure continues to be a problem particularly among those less adherent and from Xinjiang. Additional data are needed to understand the generalizability of these results, particularly those related to Xinjiang. For IDUs, enhancing adherence to HAART and considering the treatment of drug addiction as an integral part of the treatment for HIV infection should be considered. As Chinas National Free Antiretroviral Treatment Program continues to mature and improve, ramping up treatment in these settings may be important considerations to the long-term success of the program.
Export Options
About this article
Cite this article as:
Li Jingyun, Shao Yiming, Ruan Yuhua, Y. Chen Ray, Xing Hui, Liao Lingjie, Zheng Wei, Zhong Ping, Kang Laiyi, Wang Xia, Shang Hong, Yang Shaomin, Dong Yonghui, Liu Wei, Liang Shujia, Zuo La, Li Huiqin and Yang Liting, Factors Associated with HIV Virologic Failure Among Patients on HAART for One Year at Three Sentinel Surveillance Sites in China, Current HIV Research 2011; 9 (2) . https://dx.doi.org/10.2174/157016211795569122
DOI https://dx.doi.org/10.2174/157016211795569122 |
Print ISSN 1570-162X |
Publisher Name Bentham Science Publisher |
Online ISSN 1873-4251 |

- Author Guidelines
- Bentham Author Support Services (BASS)
- Graphical Abstracts
- Fabricating and Stating False Information
- Research Misconduct
- Post Publication Discussions and Corrections
- Publishing Ethics and Rectitude
- Increase Visibility of Your Article
- Archiving Policies
- Peer Review Workflow
- Order Your Article Before Print
- Promote Your Article
- Manuscript Transfer Facility
- Editorial Policies
- Allegations from Whistleblowers
Related Articles
-
A Brief Review of circRNA Biogenesis, Detection, and Function
Current Genomics Subject Index To Volume 4
Current Pharmacogenomics The Epidemiology and Health Effects of Tobacco Use
Current Pediatric Reviews Pharmacotherapy for Late-Life Depression with Psychotic Features: A Review of Literature of Randomized Control Trials
Current Psychiatry Reviews Endothelial (Dys)Function in Lone Atrial Fibrillation
Current Pharmaceutical Design Tension Type Headache
Current Rheumatology Reviews Meet Our Editorial Board Member
Current Neuropharmacology 3,4,5-Trihydroxybenzoic Acid Attenuates Ligature-Induced Periodontal Disease in Wistar Rats
Anti-Inflammatory & Anti-Allergy Agents in Medicinal Chemistry Critical Illness in Obstetric Patients: Venous Thromboembolism in Pregnancy
Current Women`s Health Reviews An Updated Patent Review on Ocular Drug Delivery Systems with Potential for Commercial Viability
Recent Patents on Drug Delivery & Formulation Partial Dopamine Agonists and the Treatment of Psychosis
Current Neuropharmacology N-(tert)-Butyloxycarbonyl-β,β-Cyclopentyl-Cysteine (Acetamidomethyl)-Methyl Ester for Synthesis of Novel Peptidomimetic Derivatives
Protein & Peptide Letters Roles of Insulin Resistance, Endothelial Dysfunction and Lifestyle Changes in the Development of Cardiovascular Disease in Diabetic Patients
Current Drug Targets Research Progress of Essential Oil as a New Complementary Therapy in the Treatment of Depression
Mini-Reviews in Medicinal Chemistry Editorial [Hot Topic: Adrenoceptors as Targets in Drug Discovery: Medicinal Chemistry and Therapeutical Potential (Guest Editors: Professors Maria Pigini and Wilma Quaglia)]
Current Topics in Medicinal Chemistry Unequivocal Role of Pyrazine Ring in Medicinally Important Compounds: A Review
Mini-Reviews in Medicinal Chemistry Lipid Nanoparticles and their Application in Nanomedicine
Current Pharmaceutical Biotechnology The Blood-Brain Barrier Choline Transporter
Central Nervous System Agents in Medicinal Chemistry Preparation, Pharmacokinetic and Application of Gold Nanoclusters (AuNCs) in Tumor Treatment
Current Medicinal Chemistry Editorial [Hot Topic: Tropical Neurology (Guest Editor: Terezinha C.B. Montelli)]
Central Nervous System Agents in Medicinal Chemistry