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Overview of HIV, Treatment, Resistance and Prospective Data - - PowerPoint PPT Presentation

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Overview of HIV, Treatment, Resistance and Prospective Data Collection in Tanzania Doreen Mloka Muhimbili University of Health Sciences (MUHAS) 2 nd EURESIST INTERNATIONAL MEETING BONN, GEMANY MAY 6 th 2011 MUHAS 2011 1 HIV Prevalence

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Overview of HIV, Treatment, Resistance and Prospective Data Collection in Tanzania

Doreen Mloka Muhimbili University of Health Sciences (MUHAS)

2nd EURESIST INTERNATIONAL MEETING BONN, GEMANY MAY 6th 2011

1 MUHAS 2011

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SLIDE 2

HIV Prevalence (15-49 yrs) by Region 2010

7.0-15.7% 0.3-3.0%

1st case 1983 - Kagera National Average: 5.7% Population: 42 million 3.3% 1.6% 1.9% 4.8% 5.1% 3.8% 5.9% 15.7% 9.2% 2.7% 6.4% 4.9% 12% 7.4% 3.4%5.6% 7.7% 1.5% 6.7% Dar- 9.3% 3.6% 1.8%

Pemba 0.3% Unguja 0.8%% Dodoma Arusha Kili. Tanga Pwani Moro- goro Lindi Mtwara Ruvuma Iringa Singida Tabora Mbeya Rukwa Kigoma Kagera Mwanza Mara Manyara Shinyanga

3.1-6.9% Percent of women and men age 15-49 who are HIV-positive NACP 2010

2 MUHAS 2011

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RESULTS HIV-1 SUBTYPE DISTRIBUTION IN COHORT

A 11% C 30% D 2% AC 31% AD 6% CD 7% ACD 13%

HISIS (n=136)

57 % recombinant 15% dual infections

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SLIDE 4
  • Wide access to ARVs initiated in October 2004

as part of the National Care and Treatment Plan

  • Major contributors:

– Government of Tanzania – Global Fund – Governments

  • f

Canada, Sweden, Norway, Netherlands and USA

– Clinton HIV/AIDS Initiative (CHAI)

Care and Treatment Services, provision of ARV’s

4 MUHAS 2011

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BASE LINE TRANSMITTED DRUG RESISTANCE DATA FROM TANZANIA BEFORE NATIONAL ARV ROLL OUT

3 COHORTS – ALL ART NAIVE 1.MBEYA REGION FEMALE SEX WORKERS – 165 (HISIS) (Mloka 2008)

  • 2. NVP COHORT (120) (Mloka 2008)

3.WOMEN ATTTENDING ANC (60) ( Somi 2008)

5 MUHAS 2011

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GENOTYPIC PRIMARY DRUG MUTATIONS AT BASE LINE

  • 1. OVERALL LOW MUTATION FREQUENCY – LESS THAN

5 %

  • 2. NO MAJOR MUTATIONS FOUND IN RT REGION
  • 3. ONLY MINOR MUTATIONS
  • V179D/E ( 23.5%)
  • V118 I (27.8%)
  • K101N ( 1.3%)
  • A98G ( 1.3%)
  • K103R ( 1.3%)

MUHAS 2011

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PROTEASE REGION

  • 1. Minor mutations

K20R/M (10.5%), M36I/V (77.6%), L36P (56%), I93V (54%), V77I (7%), A71T (1.2%), L10I/V (5.8%), and D60E (5.8%)

  • 2. Polymorphism coding for secondary

resistance to protease inhibitors was detected in over 50 % of analyzed sample e.g. L63V,L63C and L63T

MUHAS 2011

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PRO REGION PRIMARY MUTATIONS :

  • 1. L33F (1.2%) is selected by RTV, Amprenavir (APV),

Lopinavir (LPV)

  • 2. N88D (1.0%) - causes intermediate resistance to Nelfinavir

(NFV) and possibly low-level resistance to (ATV) and Saquinavir (SQV).

  • 3. L76V (1.0%) - non polymorphic mutation, that reduces

susceptibility to APV, Indinavir (IDV), and LPV, while increasing susceptibility to SQV and ATV 4. L90M (3.5%) - causes resistance to SQV and NFV. When present with other mutations it also compromises the activity

  • f IDV, RTV, APV, LPV, and ATV

5. I84V (1.2%) - causes intermediate/high-level resistance to ATV/r, FPV/r, IDV/r, NFV, and SQV/r; and low-level resistance to LPV/r, TPV/r, and DRV/r.

MUHAS 2011

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Drugs available for treatment of HIV - February, 2009

Nucleoside RTI Protease Inhibitor

AZT/ Zidovudine SQV/ Saquinavir DDI/ Didanosine D4T/ Stavudine LPV/r Lopinavir - ritonavir 3TC/ Lamivudine ABC/ Abacavir TDF/ Tenofovir

Non-Nucleoside RTI Other

NVP/ Nevirapine combination tablets: COMBIVIR , KALETRA EFV /Efavirenz and TRIOMMUNE

9 MUHAS 2011

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10 MUHAS 2011

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Total Number of people infected with HIV in care and treatment in CTC’s in Dar es Salaam as of end of June 2010

On Care On Treatment Adult - Males 31,123 20,335 Adult - Females 74,720 41,475 Children - Male 3,947 2,449 Children – Female 4,442 2,656 Total 114,232 66,915 Country wide 668,875 345,006 % of countrywide 17.1% 19.4% NACP REPORT 2010

11 MUHAS 2011

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NEXT STEP: DATA COLLECTION FOR EURESIST NETWORK Title: Transmitted and acquired HIV drug resistance in Tanzanian patients and use

  • f bioinformatics to predict new therapy

Sponsor: EDCPT Study Site: MNH, Dar es Salaam Sample size : 250 patients Status: Proposal submitted awaiting ethical clearance

12 MUHAS 2011

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SLIDE 13

Data to be collected

  • Patient Demographics
  • Clinical history including OIs and

underlying conditions

  • Patient drug history
  • Patient adherence records
  • Lab data (Viral load, CD 4 counts and

Plasma for DNA genotyping and phylogenetic analysis

13 MUHAS 2011

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Rationale

Improvement of HIV treatment and care in Tanzanian, cost effective prediction method through the Euresist data base ( HOW TO SWITCH) Rewards:

  • 1. Molecular characterization of HIV drug resistant strains

circulating.

  • 2. Determine prevalence of transmitted and acquired HIV

drug resistance in Tanzania

  • 3. Capacity building of health care personnel in Tanzania to

practice evidence based medicine through partnership and networking with international collaborators

14 MUHAS 2011

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Investigators

  • A. Muhimbili University of Health

Sciences (MUHAS)- Tanzania Ferdinand Mugusi Muhammad Bakari Sabina Mugusi

  • B. Karolinska Institute Sweden

Anders Sonnerborg Irene Bontell

15 MUHAS 2011

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Asante Sana (Thank you very much)

16 MUHAS 2011