Antiretroviral Drug Resistance Among HIV-1-lnfected Patients : A Retrospective Study
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Abstract
Background: After antiretroviral therapy (ARV) has been widely used in Thailand, the survival and quality of life are markedly improved. But the problem of drug resistance insidously progresses. Therefore, we initiate the study of HIV drug resistance in Surin Hospital for early detection of the problem.
Objectives: To study the prevalence and factors associated with HIV drug resistance in HIV-infected patient.
Setting: Surin Hospital.
Study design: Retrospective descriptive study.
Method: A retrospective reviewed of 36 HIV-infected patients, who had treatment failure at Surin Hospital during April 2001 - April 2012 was conducted. The demographic data( e.g., gender, age, sex, marital status, occupation, route of transmission) and associated factors ( e.g., initial CD4 count, initial % CD4, antiretroviral regimen, viral load and genotype drug resistance testing) were recorded and analyzed. The prevalence virological failure was assessed.
Results: There were 36 patients, who had treatment failure with mean age of
39.3 years, 66.7% were males and 33.3% were females. The prevalence of virological failure was 2.6%. The mean initial CD4 count and initial % CD4 were 62.9 cells/cu.mm. and 5.7% respectively. The mean duration of treatment was 49.9 months. Twenty five patients poor adhered to the treatment (69.4%). The most common initial antiretroviral regimen was D4T+3TC+NVP (24 patients, 66.7%) and M184V was the most common codon mutation (29%).
Conclusions: Virological failure of the first antiretroviral regimen is 2.6% and the rate is higher over time. If there is drug resistance, change antiretroviral regimen which are more expensive are needed. Physicians and patients must avoid the development of treatment failure with early detection of virologic failure and behavioral interventions such as adherence and condom usage.
Keywords: HIV drug resistance, treatment failure in HIV- infected patient
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References
2. Frank J, Kathleen M, Anne C, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. NEJM 1998;338:851-60.
3. Phanuphak P, Locharernkul C, Panmuong W, Wide H. A report of three cases of AIDS in Thailand. Asian J Allerg Immunol 1985;3:195-9.
4. ศูนย์ข้อมูลทางระบาดวิทยา สำนักระบาดวิทยา กรมควบคุมโรค กระทรวงสาธารณสุข. มีนาคม พ.ศ.2555; 350:1023 -35.
5. Calmy A, Pascual F, Ford N. HIV drug resistance. N Engl J Med. 2004 ; 350:26:2720-1.
6. Little SJ, Daar ES, D’Aquila RT, et al. Reduced antiretroviral drug susceptibility among patients with primary HIV infection. JAMA 1999; 282: 1142-9.
7. Yerly S, Kaiser L, Race E, Bru JP, Clavel F, Perrin L. Transmissionof antiretroviral- resistant HIV-1 variants. Lancet 1999, 354: 729-733.
8. Boden D, Hurley A, Zhang L, Cao Y, Guo Y, Jones E, et al. HIV-1 drug resistance in newly infected individuals. JAMA
; 282:1135-41.
9. Grymonpre RE, Didur CD, Montgomery PR, Sitar DS. Pill count, self-report, and pharmacy claims data to measure medication adherence in the elderly. Ann Pharmacother 1998; 32: 749-54.
10. Sungkanuparph S, Techasathit W, utaipiboon C, Chasombat S, Bhakeecheep S, Leechawengwongs M, et al. Thai national guidelines for antiretroviral therapy in HIV-1 infected adults and adolescents 2010. Asian Biomedicine 2010, 4:515-28.
11. Cohen J. Thailand’s do-it-yourself therapy. Science 2003; 301:5640:1662.
12. Apisarnthanarak A, Jirayasethpong T, Sa-nguansilp C, Thongprapai H, Kittiha- nukul C, Kamudamas A. et al. Antiret¬roviral drug resistance among antiretroviral-naive persons with recent HIV infection in Thailand. HIV Med 2008;9:5:322-5.
13. Lucas M, Chaisson R, Moore R. High active antiretroviral therapy in a large urban clinic: risk factors for virologic failure and adverse drug reactions. Ann Intern Med 1999;131: 2:81-7.
14. Tangvoraphonkchai K, Sungkanaparph S. The incidence and risk factors of virologic failure in HIV - infected patients receiving the first regimen of antiretroviral therapy. J Infect Dis Antimicrob Agent 2011; 28: 161-8.
15. โอภาส การย์กวินพงศ์, สม-บติ แทนประเสริฐสุข7 สัญซัย ซาสม'บติ. การดื้อยาต้านไวรัสเอ'ซไอวี ภายหลังการดำเนินโครงการพัฒนๅระนบ บริการรักษาผู้ป่วยด้วยยาต้านไวรัส จังหวัด อุบลราขธานี. วารสารโรคเอดส์ 2551;20:115-226.
16. Sethi A, Celentano D, Gange S. Association between adherence to antiretroviral therapy and human immunodeficiency virus drug resistance. CID 2003;37:1112-8.
17. Kiertiburanakul S, Sungkanaparph S. Emerging of HIV drug resistance: Epidemiology, Diagnosis, Treatment and Prevention. Current HIV Research 2009;7:273-78.
18. Sirivichayakul S, Phanuphak P, Pankam T, O-Charoen R, Sutherland D, Ruxrungtham K. et al. HIV drug resistance transmission threshold survey in Bangkok, Thailand. Antivir Ther 2008;13 Suppl 2:109-13.
19. Sungkanuparph S, Manosuthi W, Kiertiburanakul S, Piyavong B, Chumpathat N, Chantratita W. Options for the second antiretroviral regimen of HIV-infected patient failing an ignition regimen of fixed dose combination of stavudine, lamivudine and nevirapine. Clin Infect Dis 2007;44:447-52.
20. Manosuthi W, Tantanathip P, Prasithi- sirikul W, Likanonsakul S, Sungkanuparph S. Durability of stavudine, lamivudine and nevirapine among advanced HIV-1 infected patients with/without prior co-administration of rifampicin: a 144 - week prospective study. BMC Infect Dis 2008;8:136.
21. Harrigan PT, Hogg RD, Winnie WYD, Yip B, Wynhoven B, Woodward J. et al. Predictor of HIV drug-resistance mutations in a large antiretroviral-nal've cohort initiating triple antiretroviral therapy. Journal of Infectious Disease 2005;191: 339-47.
