Open Access Highly Accessed Research article

Drug resistance in HIV patients with virological failure or slow virological response to antiretroviral therapy in Ethiopia

Alemseged Abdissa12*, Daniel Yilma3, Jannik Fonager4, Anne M Audelin4, Lone H Christensen4, Mette F Olsen5, Markos Tesfaye6, Pernille Kaestel5, Tsinuel Girma7, Abraham Aseffa8, Henrik Friis5, Court Pedersen2 and Aase B Andersen2

Author Affiliations

1 Department of Medical Laboratory Sciences & Pathology, Jimma University, Jimma, Ethiopia

2 Department of Infectious Diseases, Odense University Hospital, Odense, Denmark

3 Department of Internal Medicine, Jimma University, Jimma, Ethiopia

4 Department of Microbiological Diagnostics & Virology, Statens Serum Institut, Copenhagen, Denmark

5 Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark

6 Department of Psychiatry, Jimma University, Jimma, Ethiopia

7 Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia

8 Armauer Hansen Research Institute, Addis Ababa, Ethiopia

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BMC Infectious Diseases 2014, 14:181  doi:10.1186/1471-2334-14-181

Published: 4 April 2014



The ongoing scale-up of antiretroviral therapy (ART) in sub-Saharan Africa has prompted the interest in surveillance of transmitted and acquired HIV drug resistance. Resistance data on virological failure and mutations in HIV infected populations initiating treatment in sub-Saharan Africa is sparse.


HIV viral load (VL) and resistance mutations pre-ART and after 6 months were determined in a prospective cohort study of ART-naïve HIV patients initiating first-line therapy in Jimma, Ethiopia. VL measurements were done at baseline and after 3 and 6 months. Genotypic HIV drug resistance (HIVDR) was performed on patients exhibiting virological failure (>1000 copies/mL at 6 months) or slow virological response (>5000 copies/mL at 3 months and <1000 copies/mL at 6 months).


Two hundred sixty five patients had VL data available at baseline and at 6 months. Virological failure was observed among 14 (5.3%) participants out of 265 patients. Twelve samples were genotyped and six had HIV drug resistance (HIVDR) mutations at baseline. Among virological failures, 9/11 (81.8%) harbored one or more HIVDR mutations at 6 months. The most frequent mutations were K103N and M184VI.


Our data confirm that the currently recommended first-line ART regimen is efficient in the vast majority of individuals initiating therapy in Jimma, Ethiopia eight years after the introduction of ART. However, the documented occurrence of transmitted resistance and accumulation of acquired HIVDR mutations among failing patients justify increased vigilance by improving the availability and systematic use of VL testing to monitor ART response, and underlines the need for rapid, inexpensive tests to identify the most common drug resistance mutations.