Antiretroviral treatment failure predicts mortality in rural Tanzania

Int J STD AIDS. 2015 Aug;26(9):633-9. doi: 10.1177/0956462414548460. Epub 2014 Aug 13.

Abstract

Virological monitoring of HIV-infected patients on antiretroviral treatment (ART) is rarely available in resource-limited settings and many patients experience unrecognized virological failure. We studied the long-term consequences of virological failure in rural Tanzania. Previously, virological efficacy was measured in a cohort treated with ART. In the present study, patients with virological failure (VF; HIV-RNA >400 copies/ml) were followed up and compared to those with virological response (VR; HIV-RNA <400 copies/ml) with regard to mortality, CD4 change and subsequent virological outcome. Fifty-six patients with VF had a median CD4 count of 358 cells/µl (interquartile range [IQR] 223-635) and a median HIV-RNA of 13,573 copies/ml (IQR 2326-129,736). Median CD4 count for those with VR was 499 cells/µl (IQR 290-636). During a median follow-up time of 39 months (IQR 18-42), 8 of 56 patients (14.3%) with VF died, compared to 1 of 63 patients (1.6%) with VR (p = 0.009). All registered deaths were HIV-related. Of 55 patients with subsequent HIV-RNA measurements, only 12 of 30 (40%) patients with VF achieved virological suppression, compared to 20 of 25 (80%) patients with VR (p = 0.003). Virological failure predicted death and subsequent virological failure in patients on ART in a resource-limited setting.

Keywords: AIDS; ART; CD4; HIV; antiretroviral therapy; long-term outcome; mortality; resource-limited settings; treatment; treatment failure; viral load.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Anti-HIV Agents / therapeutic use*
  • Antiretroviral Therapy, Highly Active*
  • CD4 Lymphocyte Count
  • Drug Resistance, Viral / genetics
  • Female
  • Follow-Up Studies
  • HIV Infections / drug therapy*
  • HIV Infections / mortality
  • HIV Infections / virology
  • HIV-1 / drug effects
  • HIV-1 / genetics
  • Humans
  • Male
  • Middle Aged
  • Risk Factors
  • Rural Population
  • Tanzania / epidemiology
  • Treatment Failure
  • Viral Load
  • Young Adult

Substances

  • Anti-HIV Agents