{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T23:41:40Z","timestamp":1779925300517,"version":"3.53.1"},"reference-count":38,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2018,10,2]],"date-time":"2018-10-02T00:00:00Z","timestamp":1538438400000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100008196","name":"M\u00e9decins Sans Fronti\u00e8res","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008196","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>The number of patients on second\u2010line antiretroviral therapy is growing, but data on <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> drug resistance patterns at failure in resource\u2010constrained settings are scarce. We aimed to describe drug resistance and investigate the factors associated with extensive resistance to nucleoside\/nucleotide reverse transcriptase inhibitors (<jats:styled-content style=\"fixed-case\">NRTI<\/jats:styled-content>), in patients failing second\u2010line therapy in the <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> outpatient clinic at Arua Regional Referral Hospital, Uganda.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We included patients who failed on second\u2010line therapy (two consecutive viral loads \u22651000 copies\/mm<jats:sup>3<\/jats:sup> by <jats:styled-content style=\"fixed-case\">SAMBA<\/jats:styled-content>\u20101 point\u2010of\u2010care test) and who had a drug resistance test performed between September 2014 and March 2017. Logistic regression was used to investigate factors associated with <jats:styled-content style=\"fixed-case\">NRTI<\/jats:styled-content> genotypic sensitivity score (<jats:styled-content style=\"fixed-case\">GSS<\/jats:styled-content>) \u22641.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seventy\u2010eight patients were included: 42% female, median age 31\u00a0years and median time of 29\u00a0months on second\u2010line therapy. Among 70 cases with drug resistance test results, predominant subtypes were A (47%) and D (40%); 18.5% had \u22651 major protease inhibitor mutation; 82.8% had \u22651 <jats:styled-content style=\"fixed-case\">NRTI<\/jats:styled-content> mutation and 38.5% had extensive <jats:styled-content style=\"fixed-case\">NRTI<\/jats:styled-content> resistance (<jats:styled-content style=\"fixed-case\">NRTI GSS<\/jats:styled-content> \u22641). A nadir <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>4 count \u2264100\/ml was associated with <jats:styled-content style=\"fixed-case\">NRTI GSS<\/jats:styled-content> \u22641 (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 4.2, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> [1.3\u201315.1]). Thirty (42.8%) patients were switched to third\u2010line therapy, composed of integrase inhibitor and protease inhibitor (60% darunavir\/r)\u00a0+\/\u2212\u00a0<jats:styled-content style=\"fixed-case\">NRTI<\/jats:styled-content>. A follow\u2010up viral load was available for 19 third\u2010line patients at 12\u00a0months: 84.2% were undetectable.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our study highlights the need for access to drug resistance tests to avoid unnecessary switches to third\u2010line therapy, but also for access to third\u2010line drugs, in particular integrase inhibitors. Low nadir <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>4 count might be an indicator of third\u2010line drug requirement for patients failing second\u2010line therapy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.13131","type":"journal-article","created":{"date-parts":[[2018,7,30]],"date-time":"2018-07-30T06:33:22Z","timestamp":1532932402000},"page":"1075-1083","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["<scp>HIV<\/scp>\u20101 drug resistance testing at second\u2010line regimen failure in Arua, Uganda: avoiding unnecessary switch to an empiric third\u2010line"],"prefix":"10.1111","volume":"23","author":[{"given":"F.","family":"Fily","sequence":"first","affiliation":[{"name":"Epicentre Paris France"},{"name":"Service des Maladies Respiratoires et Infectieuses H\u00f4pital Broussais Saint\u2010Malo France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Ayikobua","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res\u2010France Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Ssemwanga","sequence":"additional","affiliation":[{"name":"MRC\/UVRI Uganda Virus Research Unit Entebbe Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Nicholas","sequence":"additional","affiliation":[{"name":"Epicentre Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Kaleebu","sequence":"additional","affiliation":[{"name":"MRC\/UVRI Uganda Virus Research Unit Entebbe Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Delaugerre","sequence":"additional","affiliation":[{"name":"Laboratoire de Virologie H\u00f4pital Saint Louis AP\u2010HP Paris France"},{"name":"Universit\u00e9 Paris\u2010Diderot Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Pasquier","sequence":"additional","affiliation":[{"name":"Epicentre Paris France"},{"name":"M\u00e9decins Sans Fronti\u00e8res\u2010France Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I.","family":"Amoros Quiles","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res\u2010France Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Balkan","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res\u2010France Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Schramm","sequence":"additional","affiliation":[{"name":"Epicentre Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,10,2]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"UNAIDS.Fact Sheet \u2013 Latest Statistics on the Status of the AIDS Epidemic.2017. 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