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Article

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

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Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14000, Mexico
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Centro de Investigación y Docencia Económicas, Aguascalientes 20313, Mexico
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Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
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Center for Health Systems Research, Instituto Nacional de Salud Pública, Cuernavaca 62100, Mexico
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Dirección de Atención Integral CENSIDA, Mexico City 14080, Mexico
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Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City 14080, Mexico
*
Author to whom correspondence should be addressed.
Academic Editor: Nicola Coppola
Pathogens 2021, 10(12), 1569; https://doi.org/10.3390/pathogens10121569
Received: 29 October 2021 / Revised: 25 November 2021 / Accepted: 26 November 2021 / Published: 1 December 2021
(This article belongs to the Special Issue Current Research on HIV Drug Resistance)
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. View Full-Text
Keywords: HIV; drug resistance; surveillance; public health; Mexico HIV; drug resistance; surveillance; public health; Mexico
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MDPI and ACS Style

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. 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, 10, 1569. https://doi.org/10.3390/pathogens10121569

AMA Style

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. 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; 10(12):1569. https://doi.org/10.3390/pathogens10121569

Chicago/Turabian Style

Caro-Vega, Yanink, Fernando Alarid-Escudero, Eva A. Enns, Sandra Sosa-Rubí, Carlos Chivardi, Alicia Piñeirúa-Menendez, Claudia García-Morales, Gustavo Reyes-Terán, Juan G. Sierra-Madero, and Santiago Ávila-Ríos. 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, no. 12: 1569. https://doi.org/10.3390/pathogens10121569

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