Capacity building and predictors of success for HIV‐1 drug resistance testing in the Asia‐Pacific region and Africa

Land, Sally; Zhou, Julian Q.; Cunningham, Philip; Sohn, Annette H.; Singtoroj, Thida; Katzenstein, David; Mann, Marita; Sayer, D.; Kantor, Rami

doi:10.7448/ias.16.1.18580

Cited by 9 publications

(8 citation statements)

References 32 publications

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“…Furthermore, the ST colour indicator provides an additional cost-benefit in preventing unnecessary reagent loss. With higher ART and VL monitoring access and use of non-plasma analytes [ 78 , 79 ], the need to increase sensitivity, yield and local laboratory capacity to use such analytes will rise [ 80 ].…”

Section: Discussionmentioning

confidence: 99%

HIV diversity and drug resistance from plasma and non‐plasma analytes in a large treatment programme in western Kenya

Kantor

DeLong

Balamane

et al. 2014

Journal of the International AIDS Society

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IntroductionAntiretroviral resistance leads to treatment failure and resistance transmission. Resistance data in western Kenya are limited. Collection of non-plasma analytes may provide additional resistance information.MethodsWe assessed HIV diversity using the REGA tool, transmitted resistance by the WHO mutation list and acquired resistance upon first-line failure by the IAS–USA mutation list, at the Academic Model Providing Access to Healthcare (AMPATH), a major treatment programme in western Kenya. Plasma and four non-plasma analytes, dried blood-spots (DBS), dried plasma-spots (DPS), ViveSTTM-plasma (STP) and ViveST-blood (STB), were compared to identify diversity and evaluate sequence concordance.ResultsAmong 122 patients, 62 were treatment-naïve and 60 treatment-experienced; 61% were female, median age 35 years, median CD4 182 cells/µL, median viral-load 4.6 log10 copies/mL. One hundred and ninety-six sequences were available for 107/122 (88%) patients, 58/62 (94%) treatment-naïve and 49/60 (82%) treated; 100/122 (82%) plasma, 37/78 (47%) attempted DBS, 16/45 (36%) attempted DPS, 14/44 (32%) attempted STP from fresh plasma and 23/34 (68%) from frozen plasma, and 5/42 (12%) attempted STB. Plasma and DBS genotyping success increased at higher VL and shorter shipment-to-genotyping time. Main subtypes were A (62%), D (15%) and C (6%). Transmitted resistance was found in 1.8% of plasma sequences, and 7% combining analytes. Plasma resistance mutations were identified in 91% of treated patients, 76% NRTI, 91% NNRTI; 76% dual-class; 60% with intermediate-high predicted resistance to future treatment options; with novel mutation co-occurrence patterns. Nearly 88% of plasma mutations were identified in DBS, 89% in DPS and 94% in STP. Of 23 discordant mutations, 92% in plasma and 60% in non-plasma analytes were mixtures. Mean whole-sequence discordance from frozen plasma reference was 1.1% for plasma-DBS, 1.2% plasma-DPS, 2.0% plasma-STP and 2.3% plasma-STB. Of 23 plasma-STP discordances, one mutation was identified in plasma and 22 in STP (p<0.05). Discordance was inversely significantly related to VL for DBS.ConclusionsIn a large treatment programme in western Kenya, we report high HIV-1 subtype diversity; low plasma transmitted resistance, increasing when multiple analytes were combined; and high-acquired resistance with unique mutation patterns. Resistance surveillance may be augmented by using non-plasma analytes for lower-cost genotyping in resource-limited settings.

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Section: Discussionmentioning

confidence: 99%

HIV diversity and drug resistance from plasma and non‐plasma analytes in a large treatment programme in western Kenya

Kantor

DeLong

Balamane

et al. 2014

Journal of the International AIDS Society

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“…Genotyping was done at each study site. Local laboratories participated in an external HIV drug resistance quality assurance program for the duration of the study 14 . Resistance testing was interpreted using the Stanford University HIV Drug Resistance Database.…”

Section: Methodsmentioning

confidence: 99%

Treatment Outcomes and Resistance Patterns of Children and Adolescents on Second-Line Antiretroviral Therapy in Asia

Prasitsuebsai

Teeraananchai²,

Singtoroj

et al. 2016

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Data on pediatric treatment outcomes and drug resistance while on second-line antiretroviral therapy (ART) are needed to guide HIV care in resource-limited countries. Methods HIV-infected children <18 years old who were switched or switching to second-line ART after first-line failure were enrolled from eight sites in Indonesia, Thailand, and Vietnam. Genotyping was performed at virologic failure (VF; HIV-RNA >1000copies/mL). Cox proportional hazards regression was used to evaluate factors predicting VF. Results Of 277 children, 41% were female. At second-line switch, age was 7.5 (5.3–10.3) years, CD4 count was 300 (146–562) cells/mm3 and percentage was 13 (7–20)%; HIV-RNA was 5.0 (4.4–5.5) log10 copies/mL. Second-line regimens contained lamivudine (90%), tenofovir (43%), zidovudine or abacavir (30%), lopinavir (LPV/r; 91%), and atazanavir (ATV; 7%). After 3.3 (1.8–5.3) years on second-line ART, CD4 was 763 (556–1060) cells/mm3 and 26 (20–31)%. VF occurred in 73 (27%), with an incidence of 7.25 per 100 person-years (95% confidence interval [CI] 5.77–9.12). Resistance mutations in 50 of 73 children with available genotyping at first VF included M184V (56%), ≥1 thymidine analogue mutation (TAM; 40%), >4 TAMs (10%), Q151M (4%), any major LPV mutation (8%), >6 LPV mutations (2%), and any major ATV mutation (4%). Associations with VF included age >11 years (hazard ratio [HR] 4.06; 95%CI 2.15–7.66) and HIV-RNA >5.0 log10 copies/mL (HR 2.42; 95%CI 1.27–4.59) at switch, and was seen more commonly in children from Vietnam (HR 2.79; 95%CI 1.55 – 5.02). Conclusions One-fourth of children developed VF while on second-line ART. However, few developed major mutations to protease inhibitors.

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“…43 Education and training programs strengthen HIV/AIDS care, prevention, treatment and management skills among healthcare professionals, addressing problems such as HIV Drug Resistance (HIVDR). 44 Training programs should include interactions with PLHIV from high risk groups. 45 Policymakers should ensure that trained human resources and infrastructure are appropriately proportionate to the client load in the public health systems in general and the ART centers in particular.…”

Section: Discussionmentioning

confidence: 99%

A qualitative exploration among the staff of an antiretroviral therapy center in (central) India regarding factors associated with job satisfaction, patient satisfaction and treatment success

2018

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Background: Perception of the staff of an Anti Retroviral Therapy Center (ARTC) was explored regarding the organizational culture of the center with special reference to its effectiveness and efficiency.Methods: This qualitative exploration was conducted in the ARTC, RDGMC Ujjain. Data were collected during April 2016 and March 2018 by means of 35 self-administered-open-ended questionnaires as well as interviews (3 Focus Group Discussions and 5 Face to Face In-Depth Interviews). Data consisting of the text of the questionnaire responses and transcripts of the interview-sound files were subjected to thematic (content) analysis method.Results: Several praiseworthy features as well as deficiencies were identified, most important among them were related to counseling, behavior and management of investigations as well as treatment. Emphasis was on finding out effective and efficient ways to prevent LTFUs/ defaults/ delays. In the process of analysis of the data, three themes emerged. These are: theme 1 “general domains for attention and emphasis”; theme 2 “specific areas identified for further improvement” and theme 3 “suggestions for improvement and conclusions of the analysis of the situation”. Several measures were suggested in the interest of the PLHIV and the institution as well as for achievement of the global and national targets.Conclusions: For improvement in treatment coverage and success, escalation of certain inputs within a timeframe is essential while aiming at certain outputs is also urgently needed simultaneously. Among these, improving the staffing of the ART center in quality and quantity, the job satisfaction of the staff and patient satisfaction are extremely important.

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Capacity building and predictors of success for HIV‐1 drug resistance testing in the Asia‐Pacific region and Africa

Cited by 9 publications

References 32 publications

HIV diversity and drug resistance from plasma and non‐plasma analytes in a large treatment programme in western Kenya

HIV diversity and drug resistance from plasma and non‐plasma analytes in a large treatment programme in western Kenya

Treatment Outcomes and Resistance Patterns of Children and Adolescents on Second-Line Antiretroviral Therapy in Asia

A qualitative exploration among the staff of an antiretroviral therapy center in (central) India regarding factors associated with job satisfaction, patient satisfaction and treatment success

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