Antiretroviral therapy (ART) uptake continues to increase across sub-Saharan Africa and emergence of drug-resistant HIV mutations poses significant challenges to management of treatment-experienced patients with virologic failure. In Zambia, new third-line ART (TLART) guidelines including use of dolutegravir (DTG) were introduced in 2018. We assessed virologic suppression, immunologic response, and HIV drug-resistant mutations (DRMs) among patients on TLART at the University Teaching Hospital (UTH) in Lusaka, Zambia. We conducted a retrospective review of patients enrolled at UTH on TLART for >6 months between January 2010 and June 30, 2021. CD4 and HIV viral load (VL) at TLART initiation and post-initiation were assessed to determine virologic and immunologic outcomes. Regression analysis using bivariate and multivariate methods to describe baseline characteristics, virologic, and immunologic response to TLART was performed. A total of 345 patients met inclusion criteria; women comprised 57.6% (199/345) of the cohort. Median age at HIV diagnosis was 30 (interquartile range: 17.3–36.8). In 255 (73.8%) patients with at least two VLs, VL decreased from mean of 3.45 log₁₀ copies/mL (standard deviation [SD]: 2.02) to 1.68 log₁₀ copies/mL (SD: 1.79). Common ARVs prescribed included DTG (89.9%), tenofovir disoproxil fumarate (68.7%), and darunavir boosted with ritonavir (66.4%); 170 (49.3%) patients had genotypes; mutations consisted of 88.8% nucleoside reverse transcriptase inhibitor, 86.5% non-nucleoside reverse transcriptase inhibitor, and 55.9% protease inhibitor. VL suppression to <1,000 copies/mL was achieved in 225 (78.9%) patients. DRM frequency ranged from 56% to 89% depending on drug class. Treatment-experienced patients receiving TLART in Zambia achieved high rates of suppression despite high proportions of HIV mutations illustrating TLART effectiveness in the DTG era.

中文翻译：

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接受过三线治疗的接受过治疗的患者：赞比亚大学教学医院 HIV 高级治疗中心治疗结果的回顾性队列

抗逆转录病毒疗法 (ART) 的采用在撒哈拉以南非洲持续增加，耐药 HIV 突变的出现对治疗经历过病毒学失败的患者的管理提出了重大挑战。赞比亚于 2018 年引入了新的三线抗逆转录病毒治疗 (TLART) 指南，包括使用多替拉韦 (DTG)。我们评估了大学教学医院接受 TLART 治疗的患者的病毒学抑制、免疫反应和 HIV 耐药突变 (DRM) (UTH) 在赞比亚卢萨卡。我们对 2010 年 1 月至 2021 年 6 月 30 日期间在 UTH 接受 TLART 治疗超过 6 个月的患者进行了回顾性审查。评估了 TLART 启动时和启动后的 CD4 和 HIV 病毒载量 (VL)，以确定病毒学和免疫学结果。使用双变量和多变量方法进行回归分析，以描述基线特征、病毒学和对 TLART 的免疫反应。共有 345 名患者符合纳入标准；女性占队列的 57.6% (199/345)。HIV 诊断的中位年龄为 30 岁（四分位间距：17.3–36.8）。在至少有两个 VL 的 255 名 (73.8%) 患者中，VL 从平均值 3.45 log 下降₁₀份/mL（标准偏差 [SD]：2.02）至 1.68 log ₁₀份/mL（SD：1.79）。常见的抗逆转录病毒药物包括 DTG (89.9%)、富马酸替诺福韦地索普西 (68.7%) 和地瑞那韦加利托那韦 (66.4%)；170 (49.3%) 名患者有基因型；突变由 88.8% 的核苷逆转录酶抑制剂、86.5% 的非核苷逆转录酶抑制剂和 55.9% 的蛋白酶抑制剂组成。225 名 (78.9%) 患者实现了 VL 抑制至 <1,000 拷贝/mL。DRM 频率从 56% 到 89% 不等，具体取决于药物类别。在赞比亚接受 TLART 治疗的有治疗经验的患者实现了高抑制率，尽管 HIV 突变的比例很高，说明 TLART 在 DTG 时代的有效性。