Accumulated pre-switch resistance to more recently introduced one-pill-once-a-day antiretroviral regimens impacts HIV-1 virologic outcome

Reece, Rebecca; DeLong, Allison; D’Antuono, Matthew; Tashima, Karen T.; Kantor, Rami

doi:10.1016/j.jcv.2018.05.008

Cited by 5 publications

(6 citation statements)

References 37 publications

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“…Analyses included all available HIV-1 sequences that were ever obtained for drug resistance testing as part of routine clinical care of individuals with HIV residing in Rhode Island and in care at the adult Immunology Center or pediatric Hasbro Clinic, the two largest HIV Centers in Rhode Island, which serve $80% of the state's HIV population [21,51,54]. Demographic, clinical, and laboratory de-identified data were obtained from individuals' clinical charts, collected through routine clinical care, and included age, gender, race, ethnicity, behavior risk factors, and country of birth.…”

Section: Hiv-1 Sequences and Associated Datamentioning

confidence: 99%

Longitudinal typing of molecular HIV clusters in a statewide epidemic

Novitsky

Steingrimsson

Howison

et al. 2021

Aids

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Background: HIV molecular epidemiology is increasingly integrated into public health prevention. We conducted cluster typing to enhance characterization of a densely sampled statewide epidemic towards informing public health. Methods:We identified HIV clusters, categorized them into types, and evaluated their dynamics between 2004 and 2019 in Rhode Island. We grouped sequences by diagnosis year, assessed cluster changes between paired phylogenies, t 0 and t 1 , representing adjacent years and categorized clusters as stable (cluster in t 0 phylogeny ¼ cluster in t 1 phylogeny) or unstable (cluster in t 0 6 ¼ cluster in t 1 ). Unstable clusters were further categorized as emerging (t 1 phylogeny only) or growing (larger in t 1 phylogeny). We determined proportions of each cluster type, of individuals in each cluster type, and of newly diagnosed individuals in each cluster type, and assessed trends over time.Results: A total of 1727 individuals with available HIV-1 subtype B pol sequences were diagnosed in Rhode Island by 2019. Over time, stable clusters and individuals in them dominated the epidemic, increasing over time, with reciprocally decreasing unstable clusters and individuals in them. Conversely, proportions of newly diagnosed individuals in unstable clusters significantly increased. Within unstable clusters, proportions of emerging clusters and of individuals in them declined; whereas proportions of newly diagnosed individuals in growing clusters significantly increased over time.Conclusion: Distinct molecular cluster types were identified in the Rhode Island epidemic. Cluster dynamics demonstrated increasing stable and decreasing unstable clusters driven by growing, rather than emerging clusters, suggesting consistent in-state transmission networks. Cluster typing could inform public health beyond conventional approaches and direct interventions.

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Section: Hiv-1 Sequences and Associated Datamentioning

confidence: 99%

Longitudinal typing of molecular HIV clusters in a statewide epidemic

Novitsky

Steingrimsson

Howison

et al. 2021

Aids

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show abstract

“…HIV-1 sequences and associated data Available HIV-1 sequences obtained by the end of 2020 through drug resistance testing during routine clinical care of individuals with HIV residing in Rhode Island (RI) were utilized for analysis of cluster dynamics [11,30,31]. Demographic, clinical and laboratory deidentified data were obtained from medical records, and included sex, age at sequencing, race, ethnicity, men who have sex with men (MSM) status, prior illegal substance use, prior incarceration, prior mental health diagnoses, country of birth, year of HIV-1 diagnosis and year of sequencing.…”

Section: Methodsmentioning

confidence: 99%

“…Characteristics and major patterns of the HIV-1 epidemic in Rhode Island have been presented elsewhere [11,[29][30][31]. Here, a total of 2153 sequences were used, representing the statewide epidemic (including all available RI sequences, from >70% of diagnosed individuals [29]).…”

Section: Cohort Datasetmentioning

confidence: 99%

Not all clusters are equal: dynamics of molecular HIV-1 clusters in a statewide Rhode Island epidemic

Novitsky

Steingrimsson

Howison

et al. 2022

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Objectives: Molecular epidemiology is a powerful tool to characterize HIV epidemics and prioritize public health interventions. Typically, HIV clusters are assumed to have uniform patterns over time. We hypothesized that assessment of cluster evolution would reveal distinct cluster behavior, possibly improving molecular epidemic characterization, towards disrupting HIV transmission.Design: Retrospective cohort.Methods: Annual phylogenies were inferred by cumulative aggregation of all available HIV-1 pol sequences of individuals with HIV-1 in Rhode Island (RI) between 1990 and 2020, representing a statewide epidemic. Molecular clusters were detected in annual phylogenies by strict and relaxed cluster definition criteria, and the impact of annual newly-diagnosed HIV-1 cases to the structure of individual clusters was examined over time.Results: Of 2153 individuals, 31% (strict criteria) -47% (relaxed criteria) clustered. Longitudinal tracking of individual clusters identified three cluster types: normal, seminormal and abnormal. Normal clusters (83-87% of all identified clusters) showed predicted growing/plateauing dynamics, with approximately three-fold higher growth rates in large (15-18%) vs. small ($5%) clusters. Semi-normal clusters (1-2% of all clusters) temporarily fluctuated in size and composition. Abnormal clusters (11-16% of all clusters) demonstrated collapses and re-arrangements over time. Borderline values of cluster-defining parameters explained dynamics of non-normal clusters.Conclusions: Comprehensive tracing of molecular HIV clusters over time in a statewide epidemic identified distinct cluster types, likely missed in cross-sectional analyses, demonstrating that not all clusters are equal. This knowledge challenges current perceptions of consistent cluster behavior over time and could improve molecular surveillance of local HIV epidemics to better inform public health strategies.

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“…What are the options to decrease the pill burden in second-line antiretroviral therapy? Most of the studies simplifying ART in terms of pill burden in ART-experienced PWH are when they have had an undetectable HIV viral load for at least 6 months (as an induction-maintenance strategy) mainly in HICs [40][41][42][43]. However, there would be significant patient and population level benefits to a robust simplified secondline FDC, applicable in LMICs.…”

Section: Simplified Second-line Therapymentioning

confidence: 99%

Optimizing switching strategies to simplify antiretroviral therapy: the future of second-line from a public health perspective

Papot

Kaplan

Vitória

et al. 2021

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Accumulated pre-switch resistance to more recently introduced one-pill-once-a-day antiretroviral regimens impacts HIV-1 virologic outcome

Abstract: 12-month VL suppression with Complera/Stribild was high, suggesting that OPODs remain options even for experienced patients. Clinicians should consider resistance history before switching to OPODs and continue to focus on improving adherence.

Cited by 5 publications

References 37 publications

Longitudinal typing of molecular HIV clusters in a statewide epidemic

Longitudinal typing of molecular HIV clusters in a statewide epidemic

Not all clusters are equal: dynamics of molecular HIV-1 clusters in a statewide Rhode Island epidemic

Optimizing switching strategies to simplify antiretroviral therapy: the future of second-line from a public health perspective

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