Virological impact of HIV drug-resistance testing in children, adolescents, and adults failing first-line ART in Tanzania

IF 3.7 3区 医学 Q2 INFECTIOUS DISEASES Journal of global antimicrobial resistance Pub Date : 2024-08-27 DOI:10.1016/j.jgar.2024.07.018
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Abstract

Background

Prospective data on the effectiveness of resistance testing in informing treatment decisions and outcomes in with first-line failure in these settings is limited. This study aimed to assess the virological impact of HIV drug-resistance testing in patients with virological failure in Tanzania.

Methods

Participants were randomly assigned to either the control or the experimental group. In addition to the standard of care, patients in the experimental group had access to genotypic drug-resistance testing, information used during treatment change and were followed up at six-and 12-months to determine virological suppression.

Results

A total of 261 patients with a median age of 32 (14.7–44.7) years were enrolled. In the intention-to-treat analysis, at 6-months, suppression was achieved in 58 (42.3%; 95% CI, 34.1–50.1) experimental group patients versus 51 (41.1%; 95% CI, 32.5–49.8) control group patients, with a p-value of 0.4. At-12 months, suppression was achieved in 110 (80.3%; 95% CI, 73.6–87) experimental patients versus 99 (79.8%; 95% CI, 72.8–86.9) control patients, with a P-value of 0.5. In the per-protocol analysis, at 6-months, suppression was observed in 38.46% (95% CI, 27.6–49.3) experimental patients versus 38.6% (95% CI, 26.0–51.2) control patients, with a P-value of 0.5. At 12-months, suppression was observed in 79.49% (95% CI, 70.5–88.5) of experimental patients versus 75.44% (95% CI, 64.3–86.6) of control patients, with a P-value of 0.3.

Conclusion

Conducting HIV drug-resistance testing, and switch to individualised second-line regimens did not significantly improve virological suppression in patients experiencing first-line ART failure in Tanzania.

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坦桑尼亚一线抗逆转录病毒疗法失败的儿童、青少年和成人中艾滋病毒耐药性检测的病毒学影响。
背景:有关耐药性检测对一线治疗失败患者的治疗决策和治疗效果的影响的前瞻性数据十分有限。这项研究旨在评估耐药性检测对坦桑尼亚病毒学治疗失败患者的病毒学影响:方法:参与者被随机分配到对照组或实验组。除了接受标准治疗外,实验组患者还可接受基因型耐药性检测,这些信息用于更换治疗方案,并在6个月和12个月后接受随访,以确定病毒学抑制情况:共有 261 名患者入组,中位年龄为 32(14.7-44.7)岁。在意向治疗分析中,6 个月时,58 例(42.3%;95% CI,34.1-50.1)实验组患者达到病毒抑制,51 例(41.1%;95% CI,32.5-49.8)对照组患者达到病毒抑制,P 值为 0.4。在 12 个月时,110 名实验组患者(80.3%;95% CI,73.6-87)与 99 名对照组患者(79.8%;95% CI,72.8-86.9)实现了抑制,P 值为 0.5。在按协议分析中,6 个月时,实验组患者的抑制率为 38.46%(95% CI,27.6-49.3),对照组患者的抑制率为 38.6%(95% CI,26.0-51.2),P 值为 0.5。12 个月后,79.49%(95% CI,70.5-88.5)的实验患者与 75.44%(95% CI,64.3-86.6)的对照组患者相比,P 值为 0.3:在坦桑尼亚,对一线抗逆转录病毒疗法失败的患者进行艾滋病耐药性检测并转用个性化的二线治疗方案,并不能显著提高病毒抑制率。
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来源期刊
Journal of global antimicrobial resistance
Journal of global antimicrobial resistance INFECTIOUS DISEASES-PHARMACOLOGY & PHARMACY
CiteScore
8.70
自引率
2.20%
发文量
285
审稿时长
34 weeks
期刊介绍: The Journal of Global Antimicrobial Resistance (JGAR) is a quarterly online journal run by an international Editorial Board that focuses on the global spread of antibiotic-resistant microbes. JGAR is a dedicated journal for all professionals working in research, health care, the environment and animal infection control, aiming to track the resistance threat worldwide and provides a single voice devoted to antimicrobial resistance (AMR). Featuring peer-reviewed and up to date research articles, reviews, short notes and hot topics JGAR covers the key topics related to antibacterial, antiviral, antifungal and antiparasitic resistance.
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