High prevalence of NRTI and NNRTI drug resistance among ART-experienced, hospitalized inpatients
Journal of Acquired Immune Deficiency Syndromes — Bossard C, Schramm B, Wanjala S, et al. | June 21, 2021
In view of the high mortality risk among patients hospitalized with advanced HIV, researchers herein examined viremia and drug resistance among differentiated care services and investigated if expediting the switching of failing treatments may be justified. They assessed a total of 305 inpatients; of these, 36.7% (Kenya) and 71.2% (DRC) had viral load (VL) ≥ 1,000 copies/mL, of which 72.9% and 73.7% had dual-class drug resistance (DR). Observations revealed receipt of an ineffective first-line regimen treatment by many hospitalized, ART-experienced patients with advanced HIV. Researchers recommend integration of prompt addressing of ART failure into advanced disease care packages for this group. They recommend considering switching to effective second-line medications after a single high VL on a non-nucleoside reverse transcriptase inhibitor–based first-line if CD4 ≤ 350 cells/µL or, when VL is unavailable, among patients with CD4 ≤ 100 cells/µL.