Document Detail


Virological follow-up of adult patients in antiretroviral treatment programmes in sub-Saharan Africa: a systematic review.
MedLine Citation:
PMID:  20185094     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Following large-scale roll-out of antiretroviral therapy in sub-Saharan Africa, the non-clinical efficacy of antiretroviral therapy has received little attention. We aimed to systematically review virological efficacy and drug-resistance outcomes of programmes of antiretroviral therapy in sub-Saharan Africa. 89 studies with heterogeneous design, definitions, and methods were identified. Overall, in on-treatment analysis, 10 351 (78%) of 13 288 patients showed virological suppression after 6 months of antiretroviral therapy, 7413 (76%) of 9794 after 12 months, and 3840 (67%) of 5690 after 24 months. Long-term virological data are scarce. Genotyping results were available for patients with virological failure (HIV-1 RNA greater than 1000 copies per mL). Most patients (839 of 849; 99%) were infected with a non-B HIV-1 subtype. However, drug-resistance patterns were largely similar to those in subtype B. Resistance profiles were associated with the antiretroviral drugs commonly used: the lamivudine-associated M184V mutation was most common, followed by K103N which is associated with non-nucleoside reverse transcriptase inhibitors. Thymidine-analogue mutations and the K65R mutation were less common. First-line antiretroviral therapy regimens used in sub-Saharan Africa are effective. Profiles of drug resistance suggest that a second-line treatment regimen based on protease inhibitors, with a backbone of nucleoside reverse transcriptase inhibitors, is a reasonable option for patients with HIV in sub-Saharan Africa who experience first-line treatment failure.
Authors:
Roos E Barth; Maarten F Schim van der Loeff; Rob Schuurman; Andy I M Hoepelman; Annemarie M J Wensing
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  The Lancet. Infectious diseases     Volume:  10     ISSN:  1474-4457     ISO Abbreviation:  Lancet Infect Dis     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-02-26     Completed Date:  2010-03-23     Revised Date:  2014-08-15    
Medline Journal Info:
Nlm Unique ID:  101130150     Medline TA:  Lancet Infect Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  155-66     Citation Subset:  IM    
Copyright Information:
2010 Elsevier Ltd. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Acquired Immunodeficiency Syndrome / drug therapy*,  epidemiology
Adult
Africa South of the Sahara / epidemiology
Anti-HIV Agents / therapeutic use
Anti-Retroviral Agents / therapeutic use*
Antiretroviral Therapy, Highly Active
Female
HIV Infections / drug therapy*,  epidemiology
HIV-1 / drug effects,  pathogenicity
Humans
Male
Retroviridae Infections / drug therapy*,  epidemiology
Viral Load
Chemical
Reg. No./Substance:
0/Anti-HIV Agents; 0/Anti-Retroviral Agents

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