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Predictors of failure on second-line antiretroviral therapy with protease inhibitor mutations in Uganda

INTRODUCTION: Failure on second-line antiretroviral therapy (ART) with protease inhibitor (PI) mutations (VF-M) is on the rise. However, there is a paucity of information on the factors associated with this observation in low-income countries. Knowledge of underlying factors is critical if we are to...

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Autores principales: Musana, Hellen, Ssensamba, Jude Thaddeus, Nakafeero, Mary, Mugerwa, Henry, Kiweewa, Flavia Matovu, Serwadda, David, Ssali, Francis
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8059285/
https://www.ncbi.nlm.nih.gov/pubmed/33882938
http://dx.doi.org/10.1186/s12981-021-00338-y
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author Musana, Hellen
Ssensamba, Jude Thaddeus
Nakafeero, Mary
Mugerwa, Henry
Kiweewa, Flavia Matovu
Serwadda, David
Ssali, Francis
author_facet Musana, Hellen
Ssensamba, Jude Thaddeus
Nakafeero, Mary
Mugerwa, Henry
Kiweewa, Flavia Matovu
Serwadda, David
Ssali, Francis
author_sort Musana, Hellen
collection PubMed
description INTRODUCTION: Failure on second-line antiretroviral therapy (ART) with protease inhibitor (PI) mutations (VF-M) is on the rise. However, there is a paucity of information on the factors associated with this observation in low-income countries. Knowledge of underlying factors is critical if we are to minimize the number of PLHIV switched to costly third-line ART. Our study investigated the factors associated with VF-M. METHODS: We conducted a matched case–control analysis of patients' records kept at the Joint Clinical Research Center, starting from January 2008 to May 2018. We matched records of patients who failed the second-line ART with major PI mutations (cases) with records of patients who were virologically suppressed (controls) by a ratio of 1:3. Data analysis was conducted using STATA Version 14. Categorical variables were compared with the outcomes failure on second-line ART with PI mutations using the Chi-square and Fisher's exact tests where appropriate. Conditional logistic regression for paired data was used to assess the association between the outcome and exposure variables, employing the backward model building procedure. RESULTS: Of the 340 reviewed patients' records, 53% were women, and 6.2% had previous tuberculosis treatment. Males (aOR = 2.58, [CI 1.42–4.69]), and patients concurrently on tuberculosis treatment while on second-line ART (aOR = 5.65, [CI 1.76–18.09]) had higher odds of VF-M. ART initiation between 2001 and 2015 had lower odds of VF-M relative to initiation before the year 2001. CONCLUSION: Males and patients concomitantly on tuberculosis treatment while on second-line ART are at a higher risk of VF-M. HIV/AIDS response programs should give special attention to this group of people if we are to minimize the need for expensive third-line ART. We recommend more extensive, explorative studies to ascertain underlying factors.
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spelling pubmed-80592852021-04-21 Predictors of failure on second-line antiretroviral therapy with protease inhibitor mutations in Uganda Musana, Hellen Ssensamba, Jude Thaddeus Nakafeero, Mary Mugerwa, Henry Kiweewa, Flavia Matovu Serwadda, David Ssali, Francis AIDS Res Ther Research INTRODUCTION: Failure on second-line antiretroviral therapy (ART) with protease inhibitor (PI) mutations (VF-M) is on the rise. However, there is a paucity of information on the factors associated with this observation in low-income countries. Knowledge of underlying factors is critical if we are to minimize the number of PLHIV switched to costly third-line ART. Our study investigated the factors associated with VF-M. METHODS: We conducted a matched case–control analysis of patients' records kept at the Joint Clinical Research Center, starting from January 2008 to May 2018. We matched records of patients who failed the second-line ART with major PI mutations (cases) with records of patients who were virologically suppressed (controls) by a ratio of 1:3. Data analysis was conducted using STATA Version 14. Categorical variables were compared with the outcomes failure on second-line ART with PI mutations using the Chi-square and Fisher's exact tests where appropriate. Conditional logistic regression for paired data was used to assess the association between the outcome and exposure variables, employing the backward model building procedure. RESULTS: Of the 340 reviewed patients' records, 53% were women, and 6.2% had previous tuberculosis treatment. Males (aOR = 2.58, [CI 1.42–4.69]), and patients concurrently on tuberculosis treatment while on second-line ART (aOR = 5.65, [CI 1.76–18.09]) had higher odds of VF-M. ART initiation between 2001 and 2015 had lower odds of VF-M relative to initiation before the year 2001. CONCLUSION: Males and patients concomitantly on tuberculosis treatment while on second-line ART are at a higher risk of VF-M. HIV/AIDS response programs should give special attention to this group of people if we are to minimize the need for expensive third-line ART. We recommend more extensive, explorative studies to ascertain underlying factors. BioMed Central 2021-04-21 /pmc/articles/PMC8059285/ /pubmed/33882938 http://dx.doi.org/10.1186/s12981-021-00338-y Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Musana, Hellen
Ssensamba, Jude Thaddeus
Nakafeero, Mary
Mugerwa, Henry
Kiweewa, Flavia Matovu
Serwadda, David
Ssali, Francis
Predictors of failure on second-line antiretroviral therapy with protease inhibitor mutations in Uganda
title Predictors of failure on second-line antiretroviral therapy with protease inhibitor mutations in Uganda
title_full Predictors of failure on second-line antiretroviral therapy with protease inhibitor mutations in Uganda
title_fullStr Predictors of failure on second-line antiretroviral therapy with protease inhibitor mutations in Uganda
title_full_unstemmed Predictors of failure on second-line antiretroviral therapy with protease inhibitor mutations in Uganda
title_short Predictors of failure on second-line antiretroviral therapy with protease inhibitor mutations in Uganda
title_sort predictors of failure on second-line antiretroviral therapy with protease inhibitor mutations in uganda
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8059285/
https://www.ncbi.nlm.nih.gov/pubmed/33882938
http://dx.doi.org/10.1186/s12981-021-00338-y
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