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Jackson Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100003896","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000005","name":"U.S. Department of Defense","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000005","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2016,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> drug resistance (<jats:styled-content style=\"fixed-case\">HIVDR<\/jats:styled-content>) and determinants of virological failure in a large cohort of patients receiving first\u2010line tenofovir\u2010based antiretroviral therapy (<jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content>) regimens.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A nationwide retrospective cohort from 42 health facilities was assessed for virological failure and development of <jats:styled-content style=\"fixed-case\">HIVDR<\/jats:styled-content> mutations. Data were collected at <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> initiation and at 12 months of <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> on patients with available <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content>\u20101 viral load (<jats:styled-content style=\"fixed-case\">VL<\/jats:styled-content>) and <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> adherence measurements. <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> resistance genotyping was performed on patients with <jats:styled-content style=\"fixed-case\">VL<\/jats:styled-content> \u22651000 copies\/ml. Multiple logistic regression was used to determine factors associated with treatment failure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 828 patients, 66% were women, and the median age was 37 years. Of the 597 patients from whom blood samples were collected, 86.9% were virologically suppressed, while 11.9% were not. Virological failure was strongly associated with age &lt;25 years (adjusted odds ratio [<jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content>]: 6.4; 95% confidence interval [<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>]: 3.2\u201312.9), low adherence (<jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content>: 2.87; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 1.5\u20135.0) and baseline <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>4 counts &lt;200 cells\/<jats:italic>\u03bc<\/jats:italic>l (<jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content> 3.4; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 1.9\u20136.2). Overall, 9.1% of all patients on <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> had drug resistance mutations after 1 year of <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content>; 27% of the patients who failed treatment had no evidence of <jats:styled-content style=\"fixed-case\">HIVDR<\/jats:styled-content> mutations. <jats:styled-content style=\"fixed-case\">HIVDR<\/jats:styled-content> mutations were not observed in patients on the recommended second\u2010line <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> regimen in Rwanda.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The last step of the <jats:styled-content style=\"fixed-case\">UNAIDS<\/jats:styled-content> 90\u201090\u201090 target appears within grasp, with some viral failures still due to non\u2010adherence. Nonetheless, youth and late initiators are at higher risk of virological failure. Youth\u2010focused programmes could help prevent further drug <jats:styled-content style=\"fixed-case\">HIVDR<\/jats:styled-content> development.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.12717","type":"journal-article","created":{"date-parts":[[2016,4,30]],"date-time":"2016-04-30T10:59:54Z","timestamp":1462013994000},"page":"928-935","source":"Crossref","is-referenced-by-count":42,"title":["Drug resistance mutations after the first 12 months on antiretroviral therapy and determinants of virological failure in Rwanda"],"prefix":"10.1111","volume":"21","author":[{"given":"Jean d'Amour","family":"Ndahimana","sequence":"first","affiliation":[{"name":"HIV\/AIDS Division Rwanda Biomedical Center Kigali Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Riedel","sequence":"additional","affiliation":[{"name":"Institute of Human Virology and Division of Infectious Diseases University of Maryland Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mutagoma","family":"Mwumvaneza","sequence":"additional","affiliation":[{"name":"HIV\/AIDS Division Rwanda Biomedical Center Kigali Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dieudone","family":"Sebuhoro","sequence":"additional","affiliation":[{"name":"HIV\/AIDS Division Rwanda Biomedical Center Kigali Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean Claude","family":"Uwimbabazi","sequence":"additional","affiliation":[{"name":"Rwanda Biomedical Center Reference Laboratory Kigali Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marthe","family":"Kubwimana","sequence":"additional","affiliation":[{"name":"HIV\/AIDS Division Rwanda Biomedical Center Kigali Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jules","family":"Mugabo","sequence":"additional","affiliation":[{"name":"World Health Organization Kigali Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Augustin","family":"Mulindabigwi","sequence":"additional","affiliation":[{"name":"HIV\/AIDS Division Rwanda Biomedical Center Kigali Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Kirk","sequence":"additional","affiliation":[{"name":"Partners in Health\/Inshuti Mu Buzima Kigali Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steve","family":"Kanters","sequence":"additional","affiliation":[{"name":"School of Population and Public Health University of British Columbia Vancouver BC Canada"},{"name":"Global Evaluative Sciences Vancouver BC Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie I.","family":"Forrest","sequence":"additional","affiliation":[{"name":"School of Population and Public Health University of British Columbia Vancouver BC Canada"},{"name":"Global Evaluative Sciences Vancouver BC Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda L.","family":"Jagodzinski","sequence":"additional","affiliation":[{"name":"Walter Reed Army Institute of Research Silver Spring MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheila A.","family":"Peel","sequence":"additional","affiliation":[{"name":"Walter Reed Army Institute of Research Silver Spring MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhayimpundu","family":"Ribakare","sequence":"additional","affiliation":[{"name":"HIV\/AIDS Division Rwanda Biomedical Center Kigali Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert R.","family":"Redfield","sequence":"additional","affiliation":[{"name":"Institute of Human Virology and Division of Infectious Diseases University of Maryland Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabin","family":"Nsanzimana","sequence":"additional","affiliation":[{"name":"HIV\/AIDS Division Rwanda Biomedical Center Kigali Rwanda"},{"name":"Swiss Tropical and Public Health Institute University of Basel and Basel Institute for Clinical Epidemiology and Biostatistics Basel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,6,13]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-155-4-201108160-00358"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(14)70364-X"},{"key":"e_1_2_6_4_1","unstructured":"NsanzimanaS.Rwanda Experience towards HIV treatment as prevention. 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