Clinical and virological response to antiretroviral drugs among HIV patients on first-line treatment in Dar-es-Salaam, Tanzania

Fausta Mosha; Johanna Ledwaba; Faustine Ndugulile; Zipora Ng’ang’a; Peter Nsubuga; Lynn Morris; Mabula Kasubi; Andrew Swai; Jurgen Vercauteren; Anne-Mieke Vandamme

doi:10.3855/jidc.3879

Clinical and virological response to antiretroviral drugs among HIV patients on first-line treatment in Dar-es-Salaam, Tanzania

Authors

Fausta Mosha Ministry of Health and Social Welfare, Tanzania
Johanna Ledwaba National Institute for Communicable Diseases (NICD), South Africa
Faustine Ndugulile Ministry of Health and Social Welfare, Tanzania
Zipora Ng’ang’a Jomo Kenyatta University of Agriculture and Technology, Kenya
Peter Nsubuga Global Public Health Solutions, Atlanta, Georgia
Lynn Morris National Institute for Communicable Diseases (NICD), South Africa
Mabula Kasubi Muhimbili National Hospital, Tanzania
Andrew Swai Muhimbili National Hospital, Tanzania
Jurgen Vercauteren Rega Institute for Medical Research, University of Leuven, Leuven, Belgium
Anne-Mieke Vandamme Rega Institute for Medical Research, University of Leuven, Leuven, Belgium

DOI:

https://doi.org/10.3855/jidc.3879

Keywords:

antiretroviral drug resistance, Muhimbili hospital, Tanzania

Abstract

Introduction: In Tanzania, the follow-up on antiretroviral therapy (ART) response is based on clinical outcomes. We investigated virological response and ARV resistance mutations in relation to clinical response in ARV-treated patients.

Methodology: A cross-sectional study of a cohort of 150 patients taking first-line ART in Dar-es-Salaam was conducted. Data were collected using standardized questionnaires and patients’ blood samples. HIV viral load testing and genotyping was performed on all viremic samples. Statistical analyses compared clinical responders and non-responders.

Results: The median time on ART was 20 months; 71 (47%) patients were ART clinical responders. Clinical non-responders were more likely to have started ART with advanced disease with significantly lower median percentage weight gain (6% versus 20%) with respect to pre-treatment levels. Sixty-one (86%) and 64 (81%) of clinical responders and non-responders, respectively, had undetectable viral loads. Genotyping was successful in 24 (96%) virologically failing patients, among whom 83% had resistance mutations; 67% had dual nucleoside reverse transcriptase inhibitor (NRTI)/non-NRTI (NNRTI) resistance mutations. Seventeen (71%) and 19 (79%) patients had NRTI and NNRTI resistance mutations, respectively, which were related to the ART in use, with no difference between clinical responders and non-responders. The most prevalent subtypes were A and C, found in 9 (38%) and 7 (29%) patients, respectively.

Conclusions: The observed virological response was high and did not correlate with clinical response. The prevalence of ARV resistance mutations was high in viraemic patients and was related to the ARV prescribed. We recommend use of viral load monitoring during ART in Tanzania.

Author Biography

Fausta Mosha, Ministry of Health and Social Welfare, Tanzania

Fausta Mosha, MD (Dar es Salaam University, Tanzania); MSc. Microbiology (Katholieke University of Leuven, Belgium) and MSc. Epidemiology and Laboratory Management (Jomo Kenyatta University of Agriculture and Kenya Field Epidemiology and Laboratory Training Programme, FELTP). Dr. Mosha has been working for the Ministry of Health and Social Welfare in Tanzania since 2005, initially as a National Laboratory Training Coordinator, then as the Laboratory Resident Advisor for the Tanzania Field Epidemiology and Laboratory Training Programme. Dr. Mosha is the director for the Tanzania National Health Laboratory Quality Assurance and Training Centre. She is also a principal investigator on a CDC cooperative agreement on proficiency testing for HIV rapid tests, and biological safety cabinet certification project.

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Published

2014-07-14

How to Cite

Mosha F, Ledwaba J, Ndugulile F, Ng’ang’a Z, Nsubuga P, Morris L, Kasubi M, Swai A, Vercauteren J, Vandamme A-M (2014) Clinical and virological response to antiretroviral drugs among HIV patients on first-line treatment in Dar-es-Salaam, Tanzania. J Infect Dev Ctries 8:845–852. doi: 10.3855/jidc.3879

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Issue

Vol. 8 No. 07: July 2014

Section

Original Articles

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