Inzaule, Seth C.Kityo, Cissy M.Siwale, MargaretAkanmu, Alani SulaimonWellington, MaureenJager, Marleen deIve, PrudenceMandaliya, KishorStevens, WendyBoender, T. SoniaOndoa, PascaleSigaloff, Kim C. E.Naniche, DeniseRinke de Wit, Tobias F.Hamers, Raph L.2019-06-042019-06-042018-10-252045-2322https://hdl.handle.net/2445/134539In ART programs in sub-Saharan Africa, a growing proportion of HIV-infected persons initiating first-line antiretroviral therapy (ART) have a history of prior antiretroviral drug use (PAU). We assessed the effect of PAU on the risk of pre-treatment drug resistance (PDR) and virological failure (VF) in a multicountry cohort of HIV-infected adults initiated on a standard non-nucleoside reverse transcriptase inhibitor (NNRTI)-based first-line ART. Multivariate logistic regression was used to assess the associations between PAU, PDR and VF (defined as viral load ≥400 cps/mL). Causal mediation analysis was used to assess the proportion of the effect of PAU on VF that could be eliminated by intervening on PDR. Of 2737 participants, 122 (4.5%) had a history of PAU. Participants with PAU had a 7.2-fold (95% CI 4.4–11.7) risk of carrying PDR and a 3.1-fold (95% CI 1.6–6.1) increased risk of VF, compared to antiretroviral-naïve participants. Controlling for PDR would eliminate nearly half the effect of PAU on the risk of VF. Patients with a history of PAU are at increased risk of ART failure, which is to a large extent attributable to PDR. These findings support the recent WHO recommendations for use of differentiated, non-NNRTI-based empiric first-line therapy in patients with PAU.7 p.application/pdfengcc by (c) Inzaule et al., 2018http://creativecommons.org/licenses/by/3.0/es/Infeccions per VIHÀfrica subsaharianaAntiretroviralsHIV infectionsSub-Saharan AfricaAntiretroviral agentsinfo:eu-repo/semantics/article2019-05-27info:eu-repo/semantics/openAccess30361640