Infectious Diseases最新文献

{"title":"Treatment and Prevention of Chikungunya Fever: Current Status and Prospective","authors":"Merhawi Debesai Oqbazgi","doi":"10.5772/intechopen.98523","DOIUrl":"https://doi.org/10.5772/intechopen.98523","url":null,"abstract":"Chikungunya fever is a vector borne tropical disease that was first described in an outbreak in Tanzania. The disease is caused by Chikungunya virus (CHIKV), an alpha virus belonging to the family Togaviridae and which is transmitted from one person to another via the bite of mosquitoes. Active disease is characterized by high grade fever, pain and joint symptoms. Although debilitating at times, the disease seldom progresses to result in a serious outcome like death. There are no specific treatments for Chikungunya virus at the moment. Clinical case management is highly dependent on providing palliative care which in turn is expected to alleviate symptoms and accelerate recovery from the infection. An important element in the control of outbreaks of CHIKV infection is prevention. Preventive strategies involve initiatives like vector control, immunizations and extra care to patients with the infection. There have been several tens of researches focusing on the introduction of newer drugs and vaccines against Chikungunya. That being said, so far, no single agent has completed the entire drug or vaccine development process. Chikungunya fever is a neglected tropical disease. Although it has no specific treatment till date, the number of vaccine and drug candidates under study provides promising insights on the prospects on chikungunya treatment.","PeriodicalId":13671,"journal":{"name":"Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2021-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42765283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 and Antimicrobial Resistance: A Review.","authors":"Yusuff Adebayo Adebisi,&nbsp;Aishat Jumoke Alaran,&nbsp;Melody Okereke,&nbsp;Gabriel Ilerioluwa Oke,&nbsp;Oladunni Abimbola Amos,&nbsp;Omotayo Carolyn Olaoye,&nbsp;Iyiola Oladunjoye,&nbsp;Azeez Yusuff Olanrewaju,&nbsp;Nelson Ashinedu Ukor,&nbsp;Don Eliseo Lucero-Prisno","doi":"10.1177/11786337211033870","DOIUrl":"https://doi.org/10.1177/11786337211033870","url":null,"abstract":"<p><p>As the world continues to respond to the coronavirus pandemic (COVID-19), there is a larger hidden threat of antimicrobial resistance (AMR) lurking behind. AMR remains worrisome in that the pathogens causing resistant infections to thrive in hospitals and medical facilities, putting all patients at risk, irrespective of the severity of their medical conditions, further compounding the management of COVID-19. This study aims to provide overview of early findings on COVID-19 and AMR as well as to provide recommendations and lesson learned toward improving antimicrobial stewardship. We conducted a rapid narrative review of published articles by searching PubMed and Google Scholar on COVID-19 and Antimicrobial Resistance with predetermined keywords. Secondary bacterial infections play crucial roles in mortality and morbidity associated with COVID-19. Research has shown that a minority of COVID-19 patients need antibiotics to treat secondary bacterial infections. Current evidence reiterates the need not to give antibiotic therapy or prophylaxis to patients with mild COVID-19 or to patients with suspected or confirmed moderate COVID-19 illness unless it is indicated. The pandemic has also brought to the fore the deficiencies in health systems around the world. This comes with a lot of lessons, one of which is that despite the advances in medicine; we remain incredibly vulnerable to infections with limited or no standard therapies. This is worth thinking in the context of AMR, as the resistant pathogens are evolving and leading us to the era of untreatable infections. There is a necessity for continuous research into understanding and controlling infectious agents, as well as the development of newer functional antimicrobials and the need to strengthen the antimicrobial stewardship programs.</p>","PeriodicalId":13671,"journal":{"name":"Infectious Diseases","volume":"14 ","pages":"11786337211033870"},"PeriodicalIF":5.8,"publicationDate":"2021-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/24/99/10.1177_11786337211033870.PMC8327234.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39299270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blockade of interleukin seventeen (IL-17A) with secukinumab in hospitalized COVID-19 patients – the BISHOP study","authors":"G. Resende, Ricardo da Cruz Lage, Samara de Quadros Lobê, Amanda Medeiros, A. D. Costa e Silva, Antônio Tolentino Nogueira Sá, A. J. Oliveira, Denise Sousa, H. Guimarães, I. C. Gomes, R. P. Souza, R. S. Aguiar, Roberto Tunala, F. Forestiero, J. B. Bueno Filho, M. Teixeira","doi":"10.1080/23744235.2022.2066171","DOIUrl":"https://doi.org/10.1080/23744235.2022.2066171","url":null,"abstract":"Abstract Background Patients with severe COVID-19 seem to evolve with a compromised antiviral response and hyperinflammation. Neutrophils are critical players in COVID-19. IL-17A plays a major role in protection against extracellular pathogens and neutrophil attraction/activation. We hypothesized that secukinumab, an anti-IL17A monoclonal antibody, could prevent the deleterious hyperinflammation in COVID-19. Methods BISHOP was a randomized, open-label, single-centre, phase-II controlled trial. Fifty adult patients hospitalized with PCR-positive Covid-19, were randomized 1:1 to receive 300 mg of secukinumab subcutaneously at day-0 plus standard of care (group A) or standard of care alone (group B). A second dose of 300 mg of secukinumab could be administered on day-7, according to staff judgement. The primary endpoint was ventilator-free days at day-28 (VFD-28). Secondary efficacy and safety outcomes were also explored. Results An intention-to-treat analysis showed no difference in VFD-28: 23.7 (95%CI 19.6–27.8) in group A vs. 23.8 (19.9–27.6) in group B, p = .62; There was also no difference in hospitalization time, intensive care unit demand and the incidence of circulatory shock, acute kidney injury, fungal or bacterial co-infections. There was no difference in the incidence of severe adverse events. Pulmonary thromboembolism occurred only in males and was less frequent in secukinumab-treated patients (4.2% vs. 26.2% p = .04). There was one death in each group. Upper airway viral clearance was also similar in both groups. Conclusion The efficacy of secukinumab in the treatment of Covid19 was not demonstrated. Secukinumab decreased pulmonary embolism in male patients. There was no difference between groups in adverse events and no unexpected events were observed.","PeriodicalId":13671,"journal":{"name":"Infectious Diseases","volume":"54 1","pages":"591 - 599"},"PeriodicalIF":5.8,"publicationDate":"2021-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43820986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current Topics and Emerging Issues in Malaria Elimination","authors":"A. Rodríguez-Morales","doi":"10.5772/INTECHOPEN.87323","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.87323","url":null,"abstract":"","PeriodicalId":13671,"journal":{"name":"Infectious Diseases","volume":"1 1","pages":""},"PeriodicalIF":5.8,"publicationDate":"2021-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42561321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Candida</i> Bloodstream Infections: Changes in Epidemiology and Increase in Drug Resistance.","authors":"Fleischer Cn Kotey,&nbsp;Nicholas Tkd Dayie,&nbsp;Patience B Tetteh-Uarcoo,&nbsp;Eric S Donkor","doi":"10.1177/11786337211026927","DOIUrl":"10.1177/11786337211026927","url":null,"abstract":"<p><p>The literature on bloodstream infections (BSIs) have predominantly been biased towards bacteria, given their superior clinical significance in comparison with the other types of microorganisms. Fungal pathogens have epidemiologically received relatively less attention, although they constitute an important proportion of BSI aetiologies. In this review, the authors discuss the clinical relevance of fungal BSIs in the context of <i>Candida</i> species, as well as treatment options for the infections, emphasizing the compelling need to develop newer antifungals and strengthen antimicrobial stewardship programmes in the wake of the rapid spread of antifungal resistance.</p>","PeriodicalId":13671,"journal":{"name":"Infectious Diseases","volume":"14 ","pages":"11786337211026927"},"PeriodicalIF":5.8,"publicationDate":"2021-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/11786337211026927","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39173328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multisystem Inflammatory Syndrome in Children and Adolescents (MIS-C) under the Setting of COVID-19: A Review of Clinical Presentation, Workup and Management.","authors":"Ayesha Farooq,&nbsp;Fatima Alam,&nbsp;Asma Saeed,&nbsp;Farooq Butt,&nbsp;Muhammad Azeem Khaliq,&nbsp;Ayesha Malik,&nbsp;Manahil Chaudhry,&nbsp;Mohammad Abdullah","doi":"10.1177/11786337211026642","DOIUrl":"https://doi.org/10.1177/11786337211026642","url":null,"abstract":"<p><p>Earlier in its course, SARS-CoV-2 was primarily identified to cause an acute respiratory illness in adults, the elderly and immunocompromised, while children were known to be afflicted with milder symptoms. However, since mid-April of 2020, latent effects of the virus have begun emerging in children and adolescents, which is characterised by a multisystem hyperinflammatory state; thus, the term Multisystem Inflammatory Syndrome in Children (MIS-C) was introduced by the WHO and CDC. The syndrome manifests itself approximately 4 weeks after COVID-19 infection, with symptoms mimicking Kawasaki Disease and Kawasaki Disease Shock Syndrome. Demographically, MIS-C peaks in children aged 5 to 14 years, with clusters in Europe, North and Latin America seen, later followed by Asia. Although the exact pathophysiology behind the syndrome is unknown, recent studies have proposed a post-infectious immune aetiology, which explains the increased levels of immunoglobulins seen in affected patients. Patient presentation includes, but is not limited to, persistent fever, rash, gastrointestinal symptoms and cardiac complications including myocarditis. These patients also have raised inflammatory markers including C reactive protein, ferritin and interleukin-6. In poorly controlled patients, the syndrome can lead to multiorgan failure and death. The mainstay of treatment includes the use of intravenous immunoglobulins, steroids, immune modulators and aspirin. Adjunct therapy includes the use of low molecular weight heparin or warfarin for long term anticoagulation. Currently very little is known about the syndrome, highlighting the need for awareness amongst healthcare workers and parents. Moreover, with increased cases of COVID-19 as a result of the second wave, it is essential to keep MIS-C in mind when attending patients with a past history of COVID-19 exposure or infection. Additionally, once these patients have been identified and treated, strict follow-up must be done in order carry out long term studies, and to identify possible sequelae and complications.</p>","PeriodicalId":13671,"journal":{"name":"Infectious Diseases","volume":"14 ","pages":"11786337211026642"},"PeriodicalIF":5.8,"publicationDate":"2021-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/11786337211026642","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39148515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adherence to National Consensus Guidelines and Association with Clinical Outcomes in Patients with Candidemia.","authors":"Shauna Jacobson Junco,&nbsp;Sarah Chehab,&nbsp;Amanda Giancarelli,&nbsp;Mary Catherine Bowman,&nbsp;R Brigg Turner","doi":"10.1177/11786337211018722","DOIUrl":"https://doi.org/10.1177/11786337211018722","url":null,"abstract":"<p><strong>Background: </strong>National consensus guidelines outline recommendations for best practices in treating patients with candidemia. This study evaluated the impact of receiving care adherent to the best practice recommendations on clinical outcomes in patients with candidemia.</p><p><strong>Methods: </strong>This retrospective, multicenter study included patients with candidemia from 2010 to 2015 at 9 hospitals. The primary outcome was the composite of 30-day in-hospital mortality and 90-day candidemia recurrence. Outcomes were compared between those receiving and not receiving care adherent to the guideline recommendations. Inverse probability weights with regression adjustment were utilized to determine the average treatment effect of adherent care on the composite outcome.</p><p><strong>Results: </strong>295 patients were included with 14.2% meeting criteria for the composite outcome (11.9% mortality and 2.4% recurrence). The average treatment effect of adherent care was not significant (<i>P</i> = .75). However, receiving appropriate initial antifungal treatment and central venous catheter removal were both associated with the composite (average treatment effect of -17.5%, <i>P</i> = .011 and -8.8%, <i>P</i> = .013, respectively). In patients with a source of infection other than the central line, central venous catheter removal was not associated with the composite (<i>P</i> = .95). The most common reason for failure to receive appropriate initial antifungal treatment was omission of the loading dose.</p><p><strong>Conclusions: </strong>Central venous catheter removal and appropriate initial antifungal treatment were associated with a lower incidence of the composite of mortality and recurrence. Additional studies are needed to determine the optimal duration of therapy following candidemia clearance.</p>","PeriodicalId":13671,"journal":{"name":"Infectious Diseases","volume":"14 ","pages":"11786337211018722"},"PeriodicalIF":5.8,"publicationDate":"2021-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/11786337211018722","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39101917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment Failure and Associated Factors among Individuals on Second Line Antiretroviral Therapy in Eastern Uganda: A Retrospective Cohort Study.","authors":"Matekha Sam,&nbsp;John Peter Masette Masaba,&nbsp;Deborah Alio,&nbsp;Jayne Byakika-Tusiime","doi":"10.1177/11786337211014518","DOIUrl":"https://doi.org/10.1177/11786337211014518","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;ART failure is a growing public health problem and a major threat to the progress of HIV/AIDS control. In Uganda however, little is documented on treatment outcomes and their associated factors among individuals on second line ART regimen. The rapid scale-up of ART over the past has resulted in substantial reductions in morbidity and mortality. However, as millions of people must be maintained on ART for life, individuals with ART treatment failure are increasingly encountered and the numbers are expected to rise. This could be attributed to factors such as sub-standard regimens, limited access to routine viral load monitoring, treatment interruptions, suboptimal adherence, among others. The purpose of this study was to estimate 5-year cumulative treatment failure and the associated factors among individuals on second line ART regimen Eastern Uganda.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;A retrospective analysis of 541 records of HIV positive individuals, switched to second line ART regimen from January 2012 to December 2017. Inferential statistics including the Chi square test and multivariable logistic regression analysis was applied to determine associations of treatment failure against of the selected demographic, laboratory and clinical factors was performed. Associations between treatment failure and the predictors was based on a &lt;i&gt;P&lt;/i&gt;-value of less than 5% and confidence intervals level of 95%.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We reviewed 541 records of individuals on second line ART regimen, of which 350 (64.7%) were female, 226 (41.8%) were married, and 197 (36.4%) were older than 35 years. The mean age at ART initiation was 30 years (SD = 14.8), while the mean weight at ART initiation was 47 kg (SD = 18.6), (range 4-97 kg). The overall proportion of treatment failure was 23%. The cumulative mortality risk for 5 years was 12.4% and the mortality rate was 2.5 deaths per 100 individuals per year. The odds of developing treatment failure among individuals switched to ATV/r-based regimen were 44% lower as compared to individuals who were switched to LPV/r (OR&lt;sub&gt;adj&lt;/sub&gt;0.56, 95% CI 0.35-0.90, &lt;i&gt;P&lt;/i&gt; = .016). while the odds of experiencing treatment failure among individuals that used AZT at ART initiation were 43% lower as compared to individuals that used a TDF based regimen at ART initiation (OR&lt;sub&gt;adj&lt;/sub&gt;0.57, 95% CI 0.33-0.98, &lt;i&gt;P&lt;/i&gt; = .041).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The 5 year cumulative incidence of treatment failure in a cohort of 541 individuals was 23%. The type of protease inhibitor (PI) used in second line regimen and use of AZT at ART initiation were significantly associated with treatment failure. Our study also shows that the cumulative mortality risk while on second line ART regimen was 12.4% while the mortality rate was 2.5 deaths per 100 individuals per year. Given the high level of treatment failure among individuals on second line ART regimen, yet the current AR","PeriodicalId":13671,"journal":{"name":"Infectious Diseases","volume":"14 ","pages":"11786337211014518"},"PeriodicalIF":5.8,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/11786337211014518","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39089332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers to Human Papillomavirus Vaccine Series Completion among Insured Individuals in an Integrated Healthcare Setting.","authors":"Aruna Kamineni,&nbsp;Paula R Blasi,&nbsp;Gabrielle D Gundersen,&nbsp;Malia Oliver,&nbsp;John B Dunn,&nbsp;Denise A Galloway,&nbsp;Margaret M Madeleine","doi":"10.1177/11786337211018712","DOIUrl":"https://doi.org/10.1177/11786337211018712","url":null,"abstract":"<p><strong>Introduction: </strong>Infection with certain types of human papillomavirus (HPV) can lead to cervical cancer as well as other cancers in both men and women. However, the requirement for multiple doses may limit the vaccine's effectiveness for cancer prevention. We conducted a pilot study to investigate barriers to HPV vaccine series completion among members of an integrated healthcare system with clinical documentation of only 1 dose.</p><p><strong>Methods: </strong>We surveyed parents or legal guardians of 11-17-year-old girls (n = 10) and boys (n = 18), as well as 18-31-year-old women (n = 20) and men (n = 9), about their reasons for not completing the HPV vaccine series.</p><p><strong>Results: </strong>Most participants (70.2%) were non-Hispanic white. Among parents of children, commonly reported barriers to HPV vaccine series completion included not being aware or informed of the need for additional doses (28.6%), as well as the inconvenience of returning for additional doses (17.9%). Concerns about the HPV vaccine or vaccines in general were more common among parents of girls (30.0%) compared with parents of boys (16.7%). Among adults, barriers to HPV vaccine series completion included the inconvenience of returning for additional doses (31.0%), not being aware or informed of the need for additional doses (10.3%), and forgetting (10.3%).</p><p><strong>Conclusion: </strong>Our findings suggest that clinicians and healthcare systems can play a greater role in promoting awareness of the multiple-dose requirement, addressing vaccine concerns, and increasing opportunistic vaccination in a variety of settings. Increasing these efforts may facilitate HPV vaccine completion and increase its effectiveness in cancer prevention.</p>","PeriodicalId":13671,"journal":{"name":"Infectious Diseases","volume":"14 ","pages":"11786337211018712"},"PeriodicalIF":5.8,"publicationDate":"2021-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/11786337211018712","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39066321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High HIV-1 Virological Failure and Drug Resistance among Adult Patients Receiving First-Line ART for At least 12 Months at a Decentralized Urban HIV Clinic Setting in Senegal before the Test-and-Treat.","authors":"Aristid Ekollo Mbange, Abou Abdallah Malick Diouara, Halimatou Diop-Ndiaye, Ndèye Aminata Diaw Diouf, Ndèye Fatou Ngom-Ngueye, Kine Ndiaye Touré, Ahmed Dieng, Seynabou Lô, Mamadou Fall, Wilfred Fon Mbacham, Souleymane Mboup, Coumba Touré-Kane","doi":"10.1177/11786337211014503","DOIUrl":"10.1177/11786337211014503","url":null,"abstract":"<p><strong>Background: </strong>The feasibility of antiretroviral therapy (ART) monitoring remains problematic in decentralized HIV clinic settings of sub-Saharan Africa. We assessed the rates and correlates of HIV-1 virological failure (VF) and drug resistance (DR) in 2 pre-test-and-treat urban clinic settings of Senegal.</p><p><strong>Methods: </strong>Consenting HIV-1-infected adults (⩾18 years) receiving first-line ART for ⩾12 months were cross-sectionally enrolled between January and March 2015, at the referral outpatient treatment center of Dakar (n = 151) and decentralized regional hospital of Saint-Louis (n = 127). In the 12 months preceding plasma specimens' collection patients at Saint-Louis had no viral load (VL) testing. Significant predictors of VF (VL ⩾ 1000 copies/ml) and DR (clinically relevant mutations) were determined using binomial logistic regression in R software.</p><p><strong>Results: </strong>Of the 278 adults on EFV-/NVP-based regimens, 32 (11.5% [95%CI: 8.0-15.9]) experienced VF. Failing and non-failing patients had comparable median time [interquartile] on ART (69.5 [23.0-89.5] vs 64.0 [34.0-99.0] months; <i>P</i> = .46, Mann-Whitney <i>U</i>-test). Of the 27 viraemic isolates successfully genotyped, 20 (74.1%) carried DR mutations; most frequent were M184VI (55.6%), K103N (37.1%), thymidine analog mutations (29.6%), Y181CY (22.2%). The pattern of mutations did not always correspond to the ongoing treatment. The adjusted odds of VF was significantly associated with the decentralized clinic site (<i>P</i> < .001) and CD4 < 350 cells/mm³ (<i>P</i> < .006). Strong correlates of DR also included Saint-Louis (<i>P</i> < .009), CD4 < 350 cells/mm³ (<i>P</i> <. 001), and nevirapine-based therapies (comparator: efavirenz-based therapies; <i>P</i> < .027). In stratification analyses by site, higher rate of VF at Saint-Louis (20.5% [95%CI: 13.8-28.5] vs 4.0% [95%CI: 1.5-8.5] in Dakar) was associated with nevirapine-based therapies (OR = 3.34 [1.07-11.75], <i>P</i> = .038), self-reported missing doses (OR = 3.30 [1.13-10.24], <i>P</i> = .029), and medical appointments (OR = 2.91 [1.05-8.47], <i>P</i> = .039) in the last 1 and 12 months(s), respectively. The higher rate of DR at Saint-Louis (12.9% [95%CI: 7.6-20.1] vs 2.7% [95%CI: 0.7-6.7] in Dakar) was associated with nevirapine-based therapies (OR = 5.13 [1.12-37.35], <i>P</i> = .035).</p><p><strong>Conclusion: </strong>At decentralized urban settings, there is need for enhanced virological monitoring and adherence support. HIV programs in Senegal should intensify early HIV diagnosis for effective test-and-treat. These interventions, in addition to the superiority of efavirenz-based therapies provide a favorable framework for transitioning to the recommended potent drug dolutegravir, thereby ensuring its long-term use.</p>","PeriodicalId":13671,"journal":{"name":"Infectious Diseases","volume":"14 ","pages":"11786337211014503"},"PeriodicalIF":4.0,"publicationDate":"2021-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/aa/d3/10.1177_11786337211014503.PMC8120520.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38939758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}