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High prevalence of PI resistance in patients failing second-line ART in Vietnam.

Publication ,  Journal Article
Thao, VP; Quang, VM; Day, JN; Chinh, NT; Shikuma, CM; Farrar, J; Van Vinh Chau, N; Thwaites, GE; Dunstan, SJ; Le, T
Published in: J Antimicrob Chemother
March 2016

BACKGROUND: There are limited data from resource-limited settings on antiretroviral resistance mutations that develop in patients failing second-line PI ART. METHODS: We performed a cross-sectional virological assessment of adults on second-line ART for ≥6 months between November 2006 and December 2011, followed by a prospective follow-up over 2 years of patients with virological failure (VF) at the Hospital for Tropical Diseases, Vietnam. VF was defined as HIV RNA concentrations ≥1000 copies/mL. Resistance mutations were identified by population sequencing of the pol gene and interpreted using the 2014 IAS-USA mutation list and the Stanford algorithm. Logistic regression modelling was performed to identify predictors of VF. RESULTS: Two hundred and thirty-one patients were enrolled in the study. The median age was 32 years; 81.0% were male, 95.7% were on a lopinavir/ritonavir-containing regimen and 22 (9.5%) patients had VF. Of the patients with VF, 14 (64%) carried at least one major protease mutation [median: 2 (IQR: 1-3)]; 13 (59%) had multiple protease mutations conferring intermediate- to high-level resistance to lopinavir/ritonavir. Mutations conferring cross-resistance to etravirine, rilpivirine, tipranavir and darunavir were identified in 55%, 55%, 45% and 27% of patients, respectively. Higher viral load, adherence <95% and previous indinavir use were independent predictors of VF. The 2 year outcomes of the patients maintained on lopinavir/ritonavir included: death, 7 (35%); worsening virological/immunological control, 6 (30%); and virological re-suppression, 5 (25%). Two patients were switched to raltegravir and darunavir/ritonavir with good HIV control. CONCLUSIONS: High-prevalence PI resistance was associated with previous indinavir exposure. Darunavir plus an integrase inhibitor and lamivudine might be a promising third-line regimen in Vietnam.

Duke Scholars

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Published In

J Antimicrob Chemother

DOI

EISSN

1460-2091

Publication Date

March 2016

Volume

71

Issue

3

Start / End Page

762 / 774

Location

England

Related Subject Headings

  • Young Adult
  • Vietnam
  • Treatment Failure
  • Prospective Studies
  • Prevalence
  • Mutation
  • Middle Aged
  • Microbiology
  • Male
  • Humans
 

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Thao, V. P., Quang, V. M., Day, J. N., Chinh, N. T., Shikuma, C. M., Farrar, J., … Le, T. (2016). High prevalence of PI resistance in patients failing second-line ART in Vietnam. J Antimicrob Chemother, 71(3), 762–774. https://doi.org/10.1093/jac/dkv385
Thao, Vu Phuong, Vo Minh Quang, Jeremy N. Day, Nguyen Tran Chinh, Cecilia M. Shikuma, Jeremy Farrar, Nguyen Van Vinh Chau, Guy E. Thwaites, Sarah J. Dunstan, and Thuy Le. “High prevalence of PI resistance in patients failing second-line ART in Vietnam.J Antimicrob Chemother 71, no. 3 (March 2016): 762–74. https://doi.org/10.1093/jac/dkv385.
Thao VP, Quang VM, Day JN, Chinh NT, Shikuma CM, Farrar J, et al. High prevalence of PI resistance in patients failing second-line ART in Vietnam. J Antimicrob Chemother. 2016 Mar;71(3):762–74.
Thao, Vu Phuong, et al. “High prevalence of PI resistance in patients failing second-line ART in Vietnam.J Antimicrob Chemother, vol. 71, no. 3, Mar. 2016, pp. 762–74. Pubmed, doi:10.1093/jac/dkv385.
Thao VP, Quang VM, Day JN, Chinh NT, Shikuma CM, Farrar J, Van Vinh Chau N, Thwaites GE, Dunstan SJ, Le T. High prevalence of PI resistance in patients failing second-line ART in Vietnam. J Antimicrob Chemother. 2016 Mar;71(3):762–774.
Journal cover image

Published In

J Antimicrob Chemother

DOI

EISSN

1460-2091

Publication Date

March 2016

Volume

71

Issue

3

Start / End Page

762 / 774

Location

England

Related Subject Headings

  • Young Adult
  • Vietnam
  • Treatment Failure
  • Prospective Studies
  • Prevalence
  • Mutation
  • Middle Aged
  • Microbiology
  • Male
  • Humans