Anapenge, M

Arendt, V

Bastos, R

Biot, M

Chuquela, H C

Maldonado, F

Masquelier, C

Roman, F

Schmit, J C

Zachariah, R

English

MSF Field Research

XVII INTERNATIONAL
AIDS CONFERENCE
3-8 August 2008 | Mexico City
Poster Exhibition 
Track C - Monitoring and evaluation  
 
TUPE0353 - Low level of virological failure and drug resistance among patients receiving antiretroviral 
treatment under programme conditions in Maputo, Mozambique  
 
F. Maldonado1, M. Biot1, F. Roman2, C. Masquelier2, M. Anapenge3, R. Bastos4, H.C. Chuquela5, V. Arendt2, J.C. Schmit2, 
R. Zachariah6 
  
1Medecins sans Frontieres, Maputo, Mozambique, 2Retrovirology Laboratory, Centre de Recherche Public de la 
Santé, Luxembourg, Luxembourg, 3Central Hospital Maputo- MoH Mozambique, Maputo, Mozambique, 4Central 
Hospital Maputo- MoH Mozambique, Dermatology, Maputo, Mozambique, 5Primeiro de Maio Health Centre - City 
Health Authority-Mozambique, Maputo, Mozambique, 6Medecins sans Frontieres, Operational Research, Brussels 
Operational Centre, Brussels, Belgium 
  
Setting: Primeiro-de-Maio day clinic, Maputo, Mozambique.  
Objectives: Within a sample of individuals placed on first-line ART, we report on  
a) the feasibility of viral load monitoring using dried plasma spots (DPS) as a surveillance tool for programme performance in 
a setting where routine viral load is unavailable,  
b) the proportion of patients with virological failure and  
c) drug resistance patterns. 
Design: Cross-sectional survey.  
Methods: HIV-1 RNA viral load levels were determined using qualitative RNA-polymerase chain reaction and 
resistance mutations were sequenced using drug genotyping. The study was conducted between June and December 2006 in 
a sample of ART-naïve patients who had been on treatment for over one year.  
Results: 149 consecutive patients (69% females, median age: 36.4 years) were included after a mean follow-up time of 
23 months. 117(78.5%, 95% confidence interval CI:71-85) patients had undetectable (<400copies/ml) viral loads, while in 
32 (21%, 95% CI:14-28) this was detectable (range 437-58,884 copies/ml). Among those with virological failure only 
4(12.5%) patients were failing clinically and 3(9%) immunologically. 
Of 15 patients with viral loads above 1,000 copies/ml, twelve viruses could be sequenced and included 8 C subtypes and 
4 circulating recombinant forms CRF08. Eight (5% 95% CI:2-9) of 32 patients with detectable viral loads had one or 
more major resistance mutations. Nucleoside reverse transcriptase inhibitor (NRTI) and Non-NRTI mutations were 
observed. There were no major mutations for resistance to protease inhibitors.  
Conclusions: Among individuals placed on a first-line ART under programme conditions, the level of virological failure 
and drug resistance is reassuringly low. In resource-limited settings embarking on ART scale-up without access to routine 
viral load assays, punctual viral load surveys and targeted genotyping are useful to monitor programme quality and 
the circulation of HIV-drug-resistance strains.    
Presenting author email: bastos_rui@yahoo.com 

Low level of virological failure and drug resistance  among patients receiving antiretroviral treatment under programme conditions in Maputo, Mozambique

Low level of virological failure and drug resistance among patients receiving antiretroviral treatment under programme conditions in Maputo, Mozambique

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