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J. Lübbert, H. Tweya, T. Chaweza , J. Mwafilaso, H.Ramroth , S. Phiri,

Virological Failure and Drug Resistance in Patients on Antiretroviral Therapy after Documented Treatment Interruption in Lilongwe, Malawi. J. Lübbert, H. Tweya, T. Chaweza , J. Mwafilaso, H.Ramroth , S. Phiri, P. Schnitzler, F. Neuhann. Background.

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J. Lübbert, H. Tweya, T. Chaweza , J. Mwafilaso, H.Ramroth , S. Phiri,

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  1. Virological Failure and Drug Resistance in Patients on Antiretroviral Therapy after Documented Treatment Interruption in Lilongwe, Malawi J. Lübbert, H. Tweya, T. Chaweza, J. Mwafilaso, H.Ramroth, S. Phiri, P. Schnitzler, F. Neuhann

  2. Background • Located in Malawi‘s capital: Lilongwe • Operates 2 dayhospitals: • LighthouseClinic • Martin Preuss Centre • Since 2004: Free accessto ART in thepublicsector • Largest public sector ART provider in central region • > 14,000 patients enrolled in ART Program in 2008-2009

  3. ART in Malawi • 1stline: Triomune (NVP, 3TC and d4T) • Alternative 1stline: • EFV for NVP • ZDV for d4T • 2ndline: ZDV, 3TC, TDF, LPV/r

  4. Study Population 14,120 patients received ART (2008/2009) 341 eligible patients Documentedtreatmentinterruption Return tocare Restart 1st line 133 patients were examined for CD4 cell count and HIV RNA levels ≥ 2 months after re-initiation 40 patients had HIV RNA levels > 1000 copies/ml 93 patients had HIV RNA levels <1000 copies/ml 36 patients genotyping successful 4 patients genotyping not successful

  5. VirologicalFailure

  6. VirologicalFailure II

  7. Drug Resistance Related Mutations • No Resistance Mutation n= 4 • Resistance Mutation n=32 • NRTI Mutation n=27 • NNRTI Mutation n=32

  8. Patterns of Drug Resistance

  9. Key Findings • After documented treatment interruption 2/3 resuppressed with Malawi’s 1st line regimen • HIV RNA levels > 1000 copies/ml 88,9% had drug resistance mutations • Treatment interruption = major risk factor for virological failure. • Frequent lost of NNRTIs as a treatment option • All patients maintained the option for the current 2nd line treatment in Malawi

  10. Limitations • Limited sample size • Drug resistance only determined in patients who returned to clinic • Above average knowledge about HIV/AIDS, ART and importance of drug adherence at Lighthouse clinic ?

  11. Conclusion ≥ 2 months 1st line ? VL ART 1st line 1st line 2nd line

  12. Dr Sam Phiri Hannock Tweya and team B2C team Staff (Lighthouse and Martin Preuss) Kamuzu Central Hospital Laboratories UNC Laboratories, Lilongwe/Malawi Thank you very much for your attention!

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