LAUSR

Abstract Background Greater access and prolonged exposure to ART may inevitably lead to more treatment failure and increase the need for third-line ART (TLART) in a resource-limited setting. Objective To describe characteristics and resistance patterns of adult patients initiated on TLART in three districts of the North West province. Method All-inclusive retrospective descriptive investigation. Demographics and clinical variables were recorded from adult patient health records (2002-2017) and analysed. Results 21 Patients (17 females, 4 males) with median (IQR) age of 34 years (30.2-37.8) at HIV diagnosis and 45 years (39.5–47) at TLART initiation were included. Median duration (days) from HIV diagnosis to first-line ART initiation was 101 (37-367), treatment duration on first-line, second-line and between second-line failure and TLART initiation were: 1 269 (765–2 343); 1 512 (706-2096) and 71 (58-126) days respectively. High-level resistance most prevalent were: nelfinavir/r (85.7%), indinavir/r (80.9%), lopinavir/r (76.2%), emtricitabine and lamivudine (95.2%), nevirapine (76.2%) and efavirenz (71.4%). Resistance to 3 major PI mutations in 95% of patients and cross resistance were documented extensively. Conclusion This study support the need for earlier resistance testing. It firstly reported on time duration post diagnosis on various ART regimens and secondly resistance patterns of adults before TLART was initiated in these districts.