Orthwest Ethiopia. GUH is a referral and teaching hospital responsible forOrthwest Ethiopia. GUH is a

Orthwest Ethiopia. GUH is a referral and teaching hospital responsible for
Orthwest Ethiopia. GUH is a referral and teaching hospital responsible for the treatment of more than 8, 000 HIV infected adults and 400 children. Adult patients with WHO clinical stage 4 irrespective of CD4+ T cell count, stage 3 with CD4+ T cell count 350 cells/ mm3, or patients with CD4+ T cell count 200 cell/ mm3 in any clinical stages are eligible for ART [22]. HIV-infected children with WHO clinical stage III or IV disease (regardless of CD4 cell count) or children with CD4 percentage < 20 (for children < 18 months) or <15 (for children >18 months), regardless of clinical stage, were eligible to initiate ART [21]. However, the adult’s treatment protocol is revised since 2010 according to WHO recommendation for resource limiting settings towards initiation of ART at CD4+ T count of 350 cells/mm3 [23]. Similarly, all infants <12 VarlitinibMedChemExpress ARRY-334543 months with WHO clinical stage III or PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/26437915 IV disease (regardless of CD4 cell count) or children with CD4 percentage <20 (for children <36 months) or <15 (for children aged > 36 months), regardless of clinical stage, were eligible to initiate ART [22]. ART in Ethiopia consists of generic lowcost fixed-dose combination (FDC) of two NRTI and one NNRTI with first line regimens of lamivudine (3TC) combined with stavudine (d4T) or zidovudine (AZT), and either nevirapine (NVP) or efavirenz (EFV) (Table 1). For anaemic patients d4T substitutes AZT and for tuberculosis patients treated with rifampicin NVP replaces EFV. Co-trimoxazole prophylaxis was given to all patients included in this study. ART and care was free of charge and there were no interruptions in drug supply. In the event of first-line treatment failure, second-line regimens with addition of lopinavir/retrovir were started [21,22]. Other antiretroviral drugs such as protease, integrase and entry inhibitors as well as co-receptor antagonists are not in use. Both diagnosis of first-line treatment failure and criteria for switching to secondline drugs is PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/28854080 based on clinical findings and CD4+ T cell count as viral load is not routinely measured.Study design and selection procedureThis longitudinal study follows the WHO protocol for assessment of acquired drug resistance for adults [24]. Consecutive HIV-infected adult (N = 100) and children (N = 100) who had received first-line ART for more than 12 months and visiting Gondar Hospital from June toMulu et al. BMC Infectious Diseases 2014, 14:28 http://www.biomedcentral.com/1471-2334/14/Page 3 ofTable 1 Baseline characteristics of adult HIV/AIDS patients on ART at GUHNumber of patients Variables WHO clinical stage I II III IV Anaemia status ( )aAdults 3 11 72Children 4 6 57Dickinson, San Jose, CA, USA) following the manufacturer’s protocol. The laboratory is accredited by the American Society of Clinical Pathologists and participated in external quality control and assurance program.RNA extraction and plasma viral load determinationAnaemic Non anaemic CD4 cell count (cells/mm3)b <50 50-99 100-199 200-349 350 Total duration on ART (months) 13-24 25-36 37-48 49-60 61 ART regimen 1a: 3TC + d4T + NVP 1b: 3TC + d4T + EFV 1c: 3TC + AZT** + NVP 1d: 3TC + AZT + EFV***6267RNA was extracted from 0.6 ml of plasma with the Abbott m2000sp automated sample preparation system (Abbott Molecular, Des Plaines, IL, USA) according to manufacturer's instructions. Plasma viral load was measured using Quantitative RealTime HIV-1 assay by the Abbott m2000rt instrument with a lower detection limit of 40 copies/ml.Sequence determination.