Long-Term Effectiveness of combination Antiretroviral Therapy and Drug Resistance Patterns Among People living with HIV in Benghazi, Libya: Retrospective cohort Study (2009 – 2014)

Abstract Background The increased use of antiretroviral therapy (ART) has been accompanied by a rising incidence of HIV drug resistance, posing a significant threat to treatment efficacy. This study establishes critical baseline data to understand the evolution of resistance historically in the region. Objectives To evaluate the long-term efficacy of first-line combination ART (cART), identify the most and least effective drug combinations under Libyan guidelines, and determine the prevalence of drug resistance through genotyping. Materials and Methods A retrospective cohort study was conducted over five years (January 2009 to January 2014) focusing on 100 highly adherent Libyan patients at the Benghazi Medical Center. Viral load, CD4/CD8 counts, and hemoglobin levels were evaluated before and after five years of treatment. Results Virological response (viral load < 100 copies/mL) was achieved in 67% of cases, while 76% showed an immunological response (CD4 > 500 cells/mm³). The most effective regimen was (ABC+3TC + LPV) and (ABC+3TC + EFV). The least effective was (D4T + DDI+NVP) with 0% virological success. Genotyping was performed on 34% of patients, revealing dual-class resistance (NRTI+NNRTI) in 19% and triple-class resistance (NRTI+NNRTI + PI) in 6% of the total cohort. Conclusion While cART demonstrates robust clinical efficacy, substantial drug resistance exists. The previous first-line regimen (TDF+3TC + EFV) showed statistically suboptimal efficacy, emphasizing the urgent need for routine genotyping and transitioning to modern regimens with higher genetic barriers.