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