TY  - JOUR
A1  - Rudovick, Ladius
A1  - Brauner, Jan M.
A1  - Englert, Johanna
A1  - Seemann, Carolina
A1  - Plugaru, Karina
A1  - Kidenya, Benson R.
A1  - Kalluvya, Samuel E.
A1  - Scheller, Carsten
A1  - Kasang, Christa
T1  - Prevalence of pretreatment HIV drug resistance in Mwanza, Tanzania
JF  - Journal of Antimicrobial Chemotherapy
N2  - Background: In a 2008-10 study, we found a pretreatment HIV drug resistance (PDR) prevalence of 18.2% in patients at Bugando Medical Centre (BMC) in Mwanza, Tanzania. 

Objectives: To determine the prevalence of PDR and transmitted HIV drug resistance (TDR) in patients visiting the BMC from 2013 to 2015.

Methods: Adult outpatients were sequentially enrolled into two groups, separated by whether they were initiating ART. Previous exposure to antiretroviral drugs, except for prevention of mother-to-child transmission, was an exclusion criterion. HIV pol sequences were analysed according to WHO guidelines for surveillance of PDR and TDR.

Results: Two hundred and thirty-five sequences were analysed (138 ART initiators, 97 non-initiators). The prevalence of PDR was 4.7% (95% CI 2.6%-8.2%) overall, 3.1% (95% CI 1.1%-8.7%) for non-initiators and 5.8% (95% CI 3.0%-11.0%) for ART initiators. PDR to NNRTIs and nucleoside or nucelotide reverse transcriptase inhibitors was found in 3.0% (95% CI 1.5%-6.0%) and 1.7% (95% CI 0.7%-4.3%) of patients, respectively. Resistance to PIs was not observed. The prevalence of TDR was 6.0% (95% CI 3.6%-9.8%). 

Conclusions: Prevalence of PDR significantly decreased compared with 2008-10 and was below the WHO-defined threshold for triggering a public health response. National and systematic surveillance is needed to inform Tanzania's public health strategy.
KW  - HIV
KW  - adult
KW  - anti-hiv agents
KW  - child
KW  - mothers
KW  - nucleosides
KW  - outpatients
KW  - reverse transcriptase inhibitors
KW  - tanzania
KW  - world health organization
KW  - guidelines
KW  - public health medicine
KW  - anti-retroviral agents
KW  - non-nucleoside reverse transcriptase inhibitors
KW  - surveillance
KW  - medical
KW  - exclusion criteria
KW  - prevention
Y1  - 2018
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-227124
VL  - 73
IS  - 12
ER  - 
TY  - JOUR
A1  - Assfalg, Volker
A1  - Selig, Katharina
A1  - Tolksdorf, Johanna
A1  - van Meel, Marieke
A1  - de Vries, Erwin
A1  - Ramsoebhag, Anne‐Marie
A1  - Rahmel, Axel
A1  - Renders, Lutz
A1  - Novotny, Alexander
A1  - Matevossian, Edouard
A1  - Schneeberger, Stefan
A1  - Rosenkranz, Alexander R.
A1  - Berlakovich, Gabriela
A1  - Ysebaert, Dirk
A1  - Knops, Noël
A1  - Kuypers, Dirk
A1  - Weekers, Laurent
A1  - Muehlfeld, Anja
A1  - Rump, Lars‐Christian
A1  - Hauser, Ingeborg
A1  - Pisarski, Przemyslaw
A1  - Weimer, Rolf
A1  - Fornara, Paolo
A1  - Fischer, Lutz
A1  - Kliem, Volker
A1  - Sester, Urban
A1  - Stippel, Dirk
A1  - Arns, Wolfgang
A1  - Hau, Hans‐Michael
A1  - Nitschke, Martin
A1  - Hoyer, Joachim
A1  - Thorban, Stefan
A1  - Weinmann‐Menke, Julia
A1  - Heller, Katharina
A1  - Banas, Bernhard
A1  - Schwenger, Vedat
A1  - Nadalin, Silvio
A1  - Lopau, Kai
A1  - Hüser, Norbert
A1  - Heemann, Uwe
T1  - Repeated kidney re‐transplantation—the Eurotransplant experience: a retrospective multicenter outcome analysis
JF  - Transplant International
N2  - In Eurotransplant kidney allocation system (ETKAS), candidates can be considered unlimitedly for repeated re‐transplantation. Data on outcome and benefit are indeterminate. We performed a retrospective 15‐year patient and graft outcome data analysis from 1464 recipients of a third or fourth or higher sequential deceased donor renal transplantation (DDRT) from 42 transplant centers. Repeated re‐DDRT recipients were younger (mean 43.0 vs. 50.2 years) compared to first DDRT recipients. They received grafts with more favorable HLA matches (89.0% vs. 84.5%) but thereby no statistically significant improvement of patient and graft outcome was found as comparatively demonstrated in 1st DDRT. In the multivariate modeling accounting for confounding factors, mortality and graft loss after 3rd and ≥4th DDRT (P < 0.001 each) and death with functioning graft (DwFG) after 3rd DDRT (P = 0.001) were higher as compared to 1st DDRT. The incidence of primary nonfunction (PNF) was also significantly higher in re‐DDRT (12.7%) than in 1st DDRT (7.1%; P < 0.001). Facing organ shortage, increasing waiting time, and considerable mortality on dialysis, we question the current policy of repeated re‐DDRT. The data from this survey propose better HLA matching in first DDRT and second DDRT and careful selection of candidates, especially for ≥4th DDRT.
KW  - allocation
KW  - child
KW  - fourth
KW  - graft
KW  - kidney
KW  - loss
KW  - repeated
KW  - re‐transplantation
KW  - survival
KW  - third
Y1  - 2020
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-214161
VL  - 33
IS  - 6
SP  - 617
EP  - 631
ER  -