Retention in care, mortality, loss-to-follow-up, and viral suppression among antiretroviral treatment-naïve and experienced persons participating in a nationally representative hiv pre-treatment drug resistance survey in mexico

Yanink Caro-Vega; Fernando Alarid-Escudero; Eva A. Enns; Sandra Sosa-Rubí; Carlos Chivardi; Alicia Piñeirúa-Menendez; Claudia García-Morales; Gustavo Reyes-Terán; Juan G. Sierra-Madero; Santiago Ávila-Ríos

doi:10.3390/pathogens10121569

Retention in care, mortality, loss-to-follow-up, and viral suppression among antiretroviral treatment-naïve and experienced persons participating in a nationally representative hiv pre-treatment drug resistance survey in mexico

Yanink Caro-Vega, Fernando Alarid-Escudero, Eva A. Enns, Sandra Sosa-Rubí, Carlos Chivardi, Alicia Piñeirúa-Menendez, Claudia García-Morales, Gustavo Reyes-Terán, Juan G. Sierra-Madero, Santiago Ávila-Ríos

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Abstract

We describe associations of pretreatment drug resistance (PDR) with clinical outcomes such as remaining in care, loss to follow-up (LTFU), viral suppression, and death in Mexico, in real-life clinical settings. We analyzed clinical outcomes after a two-year follow up period in participants of a large 2017–2018 nationally representative PDR survey cross-referenced with information of the national ministry of health HIV database. Participants were stratified according to prior ART exposure and presence of efavirenz/nevirapine PDR. Using a Fine-Gray model, we evaluated virological suppression among resistant patients, in a context of competing risk with lost to follow-up and death. A total of 1823 participants were followed-up by a median of 1.88 years (Interquartile Range (IQR): 1.59–2.02): 20 (1%) were classified as experienced + resistant; 165 (9%) naïve + resistant; 211 (11%) experienced + non-resistant; and 1427 (78%) as naïve + non-resistant. Being ART-experienced was associated with a lower probability of remaining in care (adjusted Hazard Ratio(aHR) = 0.68, 0.53–0.86, for the non-resistant group and aHR = 0.37, 0.17–0.84, for the resistant group, compared to the naïve + non-resistant group). Heterosexual cisgender women compared to men who have sex with men [MSM], had a lower viral suppression (aHR = 0.84, 0.70–1.01, p = 0.06) ART-experienced persons with NNRTI-PDR showed the worst clinical outcomes. This group was enriched with women and persons with lower education and unemployed, which suggests higher levels of social vulnerability.

Original language	English (US)
Article number	1569
Journal	Pathogens
Volume	10
Issue number	12
DOIs	https://doi.org/10.3390/pathogens10121569
State	Published - Nov 2021

Bibliographical note

Funding Information:
Funding: This work was supported by Consejo Nacional de Ciencia y Tecnología (CONACyT SALUD-2017-01-289725), the Mexican Government (Programa Presupuestal P016; Anexo 13 del Decreto del Presupuesto de Egresos de la Federación), and the Canadian Institutes of Health Research (grants PJT-148621 and PJT-159625). E.A.E., F.A.-E. and C.C. had funding provided by the Center for Global Health and Social Responsibility at the University of Minnesota. August 2018–July 2019.

Funding Information:
This work was supported by Consejo Nacional de Ciencia y Tecnolog?a (CONACyT SALUD-2017-01-289725), the Mexican Government (Programa Presupuestal P016; Anexo 13 del Decreto del Presupuesto de Egresos de la Federaci?n), and the Canadian Institutes of Health Research (grants PJT-148621 and PJT-159625). E.A.E., F.A.-E. and C.C. had funding provided by the Center for Global Health and Social Responsibility at the University of Minnesota. August 2018?July 2019.

Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

Keywords

Drug resistance
HIV
Mexico
Public health
Surveillance

UN SDGs

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Caro-Vega, Y., Alarid-Escudero, F., Enns, E. A., Sosa-Rubí, S., Chivardi, C., Piñeirúa-Menendez, A., García-Morales, C., Reyes-Terán, G., Sierra-Madero, J. G., & Ávila-Ríos, S. (2021). Retention in care, mortality, loss-to-follow-up, and viral suppression among antiretroviral treatment-naïve and experienced persons participating in a nationally representative hiv pre-treatment drug resistance survey in mexico. Pathogens, 10(12), Article 1569. https://doi.org/10.3390/pathogens10121569

Retention in care, mortality, loss-to-follow-up, and viral suppression among antiretroviral treatment-naïve and experienced persons participating in a nationally representative hiv pre-treatment drug resistance survey in mexico. / Caro-Vega, Yanink; Alarid-Escudero, Fernando; Enns, Eva A. et al.
In: Pathogens, Vol. 10, No. 12, 1569, 11.2021.

Research output: Contribution to journal › Article › peer-review

Caro-Vega, Y, Alarid-Escudero, F, Enns, EA, Sosa-Rubí, S, Chivardi, C, Piñeirúa-Menendez, A, García-Morales, C, Reyes-Terán, G, Sierra-Madero, JG & Ávila-Ríos, S 2021, 'Retention in care, mortality, loss-to-follow-up, and viral suppression among antiretroviral treatment-naïve and experienced persons participating in a nationally representative hiv pre-treatment drug resistance survey in mexico', Pathogens, vol. 10, no. 12, 1569. https://doi.org/10.3390/pathogens10121569

Caro-Vega Y, Alarid-Escudero F, Enns EA, Sosa-Rubí S, Chivardi C, Piñeirúa-Menendez A et al. Retention in care, mortality, loss-to-follow-up, and viral suppression among antiretroviral treatment-naïve and experienced persons participating in a nationally representative hiv pre-treatment drug resistance survey in mexico. Pathogens. 2021 Nov;10(12):1569. doi: 10.3390/pathogens10121569

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abstract = "We describe associations of pretreatment drug resistance (PDR) with clinical outcomes such as remaining in care, loss to follow-up (LTFU), viral suppression, and death in Mexico, in real-life clinical settings. We analyzed clinical outcomes after a two-year follow up period in participants of a large 2017–2018 nationally representative PDR survey cross-referenced with information of the national ministry of health HIV database. Participants were stratified according to prior ART exposure and presence of efavirenz/nevirapine PDR. Using a Fine-Gray model, we evaluated virological suppression among resistant patients, in a context of competing risk with lost to follow-up and death. A total of 1823 participants were followed-up by a median of 1.88 years (Interquartile Range (IQR): 1.59–2.02): 20 (1%) were classified as experienced + resistant; 165 (9%) na{\"i}ve + resistant; 211 (11%) experienced + non-resistant; and 1427 (78%) as na{\"i}ve + non-resistant. Being ART-experienced was associated with a lower probability of remaining in care (adjusted Hazard Ratio(aHR) = 0.68, 0.53–0.86, for the non-resistant group and aHR = 0.37, 0.17–0.84, for the resistant group, compared to the na{\"i}ve + non-resistant group). Heterosexual cisgender women compared to men who have sex with men [MSM], had a lower viral suppression (aHR = 0.84, 0.70–1.01, p = 0.06) ART-experienced persons with NNRTI-PDR showed the worst clinical outcomes. This group was enriched with women and persons with lower education and unemployed, which suggests higher levels of social vulnerability.",

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Retention in care, mortality, loss-to-follow-up, and viral suppression among antiretroviral treatment-naïve and experienced persons participating in a nationally representative hiv pre-treatment drug resistance survey in mexico

Abstract

Bibliographical note

Keywords

UN SDGs

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