A Retrospective Survey of HIV Drug Resistance among Patients One Year after Initiation of Antiretroviral Therapy at Four Clinics in Malawi

Journal Article
  • Nellie Wadonda-Kabondo
  • Bethany L. Hedt
  • Joep J. van Oosterhout
  • Kundai Moyo
  • Eddie Limbambala
  • George Bello
  • Ben Chilima
  • Erik Schouten
  • Anthony Harries
  • Moses Massaquoi
  • Carol Porter
  • Ralf Weigel
  • Mina Hosseinipour
  • John Aberle-Grasse
  • Michael R. Jordan
  • Storn Kabuluzi
  • Diane E. Bennett
Clinical Infectious Diseases
54 (4) (May 2012). doi:10.1093/cid/cis004.

In 2004, Malawi began scaling up its national antiretroviral therapy (ART) program. Because of limited treatment options, population-level surveillance of acquired human immunodeficiency virus drug resistance (HIVDR) is critical to ensuring long-term treatment success. The World Health Organization target for clinic-level HIVDR prevention at 12 months after ART initiation is ≥70%. In 2007, viral load and HIVDR genotyping was performed in a retrospective cohort of 596 patients at 4 ART clinics. Overall, HIVDR prevention (using viral load ≤400 copies/mL) was 72% (95% confidence interval [CI], 67%–77%; range by site, 60%–83%) and detected HIVDR was 3.4% (95% CI, 1.8%–5.8%; range by site, 2.5%–4.7%). Results demonstrate virological suppression and HIVDR consistent with previous reports from sub-Saharan Africa. High rates of attrition because of loss to follow-up were noted and merit attention.