Abstract:
Background: Expanded access to combination antiretroviral therapy (cART) throughout sub-Saharan Africa over the
last decade has remarkably improved the prognosis of persons living with HIV (PLWH). However, some PLWH experience
virologic rebound after a period of viral suppression, usually followed by selection of drug resistant virus. Determining
factors associated with drug resistance can inform patient management and healthcare policies, particularly in
resource-limited settings where drug resistance testing is not routine.
Methods: A case–control study was conducted using data captured from an electronic medical record in a large
treatment program in Nigeria. Cases PLWH receiving cART who developed acquired drug resistance (ADR) and
controls were those without ADR between 2004 and 2011. Each case was matched to up to 2 controls by sex, age,
and education. Logistic regression was used estimate odds ratios (ORs) and 95% confidence intervals (CIs) for factors
associated with ADR.
Results: We evaluated 159 cases with ADR and 299 controls without ADR. In a multivariate model, factors associated
with ADR included older age (OR = 2.35 [age 30–40 years 95% CI 1.29, 4.27], age 41 + years OR = 2.31 [95% CI 1.11,
4.84], compared to age 17–30), higher education level (secondary OR 2.14 [95% CI 1.1.11–4.13]), compared to primary
and tertiary), non-adherence to care (OR = 2.48 [95% CI 1.50–4.00]), longer treatment duration (OR = 1.80 [95% CI
1.37–2.35]), lower CD4 count((OR = 0.95 [95% CI 0.95–0.97]) and higher viral load (OR = 1.97 [95% CI 1.44–2.54]).
Conclusions: Understanding these predictors may guide programs in developing interventions to identify patients
at risk of developing ADR and implementing prevention strategies
