A multidisciplinary approach for people with HIV failing antiretroviral therapy in South Africa.

Autor:	Juta PM; Department of Internal Medicine, Faculty of Health Sciences, School of Medicine, University of KwaZulu-Natal, Pietermaritzburg, South Africa., Jansen van Vuuren JM; Department of Internal Medicine, Faculty of Health Sciences, School of Medicine, University of KwaZulu-Natal, Durban, South Africa.; Department of Internal Medicine, Joint Royal Colleges of Physicians Training Board, National Health Service (NHS) England, Chelmsford, United Kingdom., Mbaya KJ; KwaZulu-Natal Department of Health, Northdale Hospital, Pietermaritzburg, South Africa.; Department of Family Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
Jazyk:	angličtina
Zdroj:	Southern African journal of HIV medicine [South Afr J HIV Med] 2024 Jul 22; Vol. 25 (1), pp. 1579. Date of Electronic Publication: 2024 Jul 22 (Print Publication: 2024).
DOI:	10.4102/sajhivmed.v25i1.1579
Abstrakt:	Background: South Africa (SA) has the largest antiretroviral therapy (ART) programme worldwide. Multiple factors contribute to virological failure (VF), including poor adherence and viral resistance mutations. A multidisciplinary team (MDT) clinic dedicated to those with VF may be of benefit; however, very little data from SA exist. Objectives: To assess whether an MDT approach achieved virological suppression (VS) in patients failing second-line-ART (2LART); assess the number of MDT sessions required to achieve VS; assess local resistance mutation patterns and whether the MDT reduced the number of genotypic resistance testing (GRT) required. Method: An observational, retrospective, cross-sectional chart review study was conducted between January 2018 and December 2019 at a Target High Viral Load (VL) MDT clinic in KwaZulu-Natal, SA. Results: Ninety-seven medical records were eligible. Women accounted for 63% of patients, with a mean age of 37 years. A significant reduction in the first VL measurement following the MDT was seen (median reduction 2374 c/mL; P < 0.001). This was maintained at the second VL measurement post-MDT (median reduction 2957 c/mL; P < 0.001). Patients attended a mean of 2.71 MDT sessions and 73.2% achieved VS, resulting in 61.86% fewer GRTs required. Of the GRTs performed, nucleoside reverse transcriptase inhibitors and non-nucleoside reverse transcriptase inhibitor-related mutations were noted most frequently. Conclusion: The MDT approach resulted in a significant reduction in VL, with most participants achieving VS. The MDT was successful in reducing the need for GRT. Resistance mutations were similar to those found in other studies conducted across SA. Competing Interests: The authors have declared that they have no financial or personal relationships that may have inappropriately influenced them in writing this article. (© 2024. The Authors.)
Databáze:	MEDLINE
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