HIV-1 drug resistance in antiretroviral-naive individuals in sub-Saharan Africa after rollout of antiretroviral therapy: a multicentre observational study

Hamers, Raph L; Wallis, Carole L.; Kityo, Cissy; Siwale, Margaret; Mandaliya, Kishor; Conradie, Francesca; Botes, Mariëtte E.; Wellington, Maureen; Osibogun, Akin; Sigaloff, Kim C.E.; Nankya, Immaculate; Schuurman, Rob; Wit, Ferdinand W. N. M.; Stevens, Wendy; Vugt, Michèle van; Wit, Tobias F. Rinke de

doi:10.1016/s1473-3099(11)70149-9

Cited by 267 publications

(238 citation statements)

References 33 publications

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Section: Discussionmentioning

confidence: 99%

“…Adherence in adolescents has been reported to be poorer than in younger children, and older adults in both resourced rich and limited settings [18]. Reasons include adolescents' risk taking behavior, the stage of development when thought and reasoning is not fully developed, and regimen fatigue [18,38]. As perinatally infected HIV children who have been on ARVs grow into adolescence, adherence was found to decrease because of long period on medication [18,19,[36][37][38].…”

Section: Discussionmentioning

confidence: 99%

“…Reasons include adolescents' risk taking behavior, the stage of development when thought and reasoning is not fully developed, and regimen fatigue [18,38]. As perinatally infected HIV children who have been on ARVs grow into adolescence, adherence was found to decrease because of long period on medication [18,19,[36][37][38]. Some studies have reported adherence rates for long term prescription medications to be between 50-75% [18,19].…”

Section: Discussionmentioning

confidence: 99%

“…As perinatally infected HIV children who have been on ARVs grow into adolescence, adherence was found to decrease because of long period on medication [18,19,[36][37][38]. Some studies have reported adherence rates for long term prescription medications to be between 50-75% [18,19]. In the present study, adolescents between 9-18 years (90.4%) were switched to 2 nd line medications, thus bringing into focus the issue of adherence to medications among adolescent, and the need to find a lasting solution to this reoccurring decimal.…”

Section: Discussionmentioning

confidence: 99%

“…Growing number patients in the developing countries have switched to 2 nd line therapy, and some requiring 3 rd line medications [18][19][20]. Failure to 1 st line ART has been documented in 13% of HIV-infected Uganda children [9], 16% in South Africa [21], 16% in Thailand [22], 33% in Kenya [23], 44% in Mali [24], 9.1% in another South African study [25], and 0.8% from a multi-center study in Africa and Asia [26].…”

Section: Research Articlementioning

confidence: 99%

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First and Second Line Highly Active Anti-Retroviral Therapy Failure in HIV Infected Nigerian Children at University of Abuja Teaching Hospital Gwagwalada, Nigeria

Aa¹

2015

J HIV Clin Sci Res

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Background: In high-income countries, viral load is routinely used for monitoring HIV patients on antiretroviral therapy for early detection of drug failure. This is not the case in most resource limited settings like ours where only WHO immunological and clinical criteria are used for monitoring. This study is aimed at determining the rate/time of failure to 1 st and 2 nd antiretroviral drugs in children in our centers.Method: Is a retrospective study of children ≤18 years switched to 2 nd line antiretroviral regimen and those requiring third line drugs from Jan 2006 to June 2015 in our health institution. Data analysis was conducted using SPSS version 16.0 software and statistical significance set at p < 0.05. Result:Sixteen percent (82/514) of children on 1 st line medication were switched to 2 nd line drugs with switch over rate of 9 persons/year, and 6/82 (7.3%) required 3 rd line medication. The median switch over time was 31.3 months (IQR 26.4-36.2) for 2 nd line medication, and 42.6 months (IQR 40.1-44.3) from time of switch to 2 nd line drugs for those requiring 3 rd line regimen. Over 90% of patients switched to 2 nd line drugs were between 9-18 years, none was an infant. The mean CD4 cell count and viral load before switch to 2 nd line drugs were 109.09±29.23 cell/mm 3 and 180,480.29±35,303 copies/ ml, and 89.42±28.67 cell/mm 3 / 237,337.5±64,619 copies/ml for those requiring 3 rd line medications. There was over 450 fold increase in viral load from the expected undetectable level of 400 copies/ml after 6 months on medication before patients were switch to 2 nd line drugs, and over 590 folds increase for those that require 3 rd line medications. Significant difference was seen in the mean CD4 cell count and weight of those with adherence of ≥ 95% and ≤ 95% (p values were <0.05). Conclusion:WHO immunological and clinical criteria were found not to be ideal for monitoring of children on antiretroviral therapy. Six monthly viral load monitoring and resistance testing should be introduced in Nigerian guideline for managing HIV children for better therapeutic and pharmacoeconomic outcomes. Third line medication should also be made available in the country and intensification of adherence is required in adolescent age group.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Research Articlementioning

confidence: 99%

See 3 more Smart Citations

First and Second Line Highly Active Anti-Retroviral Therapy Failure in HIV Infected Nigerian Children at University of Abuja Teaching Hospital Gwagwalada, Nigeria

Aa¹

2015

J HIV Clin Sci Res

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HIV‐1 drug resistance‐associated mutations among antiretroviral‐naive thai patients with chronic HIV‐1 infection

Manosuthi

Thongyen

Nilkamhang

et al. 2012

Journal of Medical Virology

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Antiretroviral therapy (ART) has increased in resource-limited settings. This study determined the prevalence of HIV-1 drug resistance-associated mutations (DRAMs) among patients with chronic HIV-1 infections and compare DRAMs between CRF01_AE and B subtypes. ART-naive Thai patients who had ART initiation between 2010 and 2011 were enrolled prospectively. Genotypic assays were performed on viral reverse transcriptase and protease genes within 4 weeks before starting ART. DRAMs were assessed using the International AIDS Society-USA 2011 list. A total of 330 patients were included. HIV-1 subtypes included CRF01_AE (73%), B (23.9%), and others (3.1%). Median (IQR) CD4+ was 66 (23-172) cells/mm(3) and median (IQR) HIV-1 RNA was 5.2 (4.6-5.8) log copies/ml. The prevalence of patients with ≥1 DRAMs for any antiretroviral agents was 17.6%. DRAM prevalence was 17% for non-nucleoside reverse transcriptase inhibitors (NNRTIs), 0.6% for NRTIs, and 0.6% for protease inhibitors (PIs). DRAMs to NNRTIs were V106I (7%), V179D (4.2%), V179T (1.8%), E138A (1.5%), V90I (1.2%), K103N (0.9%), Y181C (0.9%), and P225H (0.3%). DRAMs to NRTIs were M184V (0.3%) and T215S (0.3%). The only major DRAM for PIs was M46L (0.6%). Minor DRAMs to PIs including I13V, M36I, H69K, and L89M were observed more frequently in CRF_01 AE. By multivariate analysis, the factors "HIV-1 subtype B" and "low pretreated CD4+ cell count" were associated with a higher rate of DRAMs. HIV-1 DRAMs, especially to NNRTIs, are emerging in a middle-income country after widespread use of NNRTI-based ART. HIV genotypic assays before ART initiation in patients with chronic HIV-1 infection should be considered.

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Transmitted HIV drug resistance in treatment‐naive Romanian patients

Temereanca

Ene

Mehta

et al. 2013

Journal of Medical Virology

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Transmitted HIV drug resistance (TDR) remains an important concern for individuals unexposed to antiretroviral treatment. Data on the prevalence of TDR, available mainly for HIV-1 subtype B, are now also emerging for other subtypes. In Romania, a steady predominance of subtype F was reported among both long-term survivor children and newly infected adults. The pol gene of 61 drug-naïve patients infected with HIV, diagnosed between 1997 and 2011 was sequenced in order to analyze the prevalence of primary resistance mutations and to correlate these with the infecting genotype. Only 5/61 specimens were classified as infected recently using the BED-Capture Enzyme Immunoassay. Subtype F1 was prevalent (80.3%), however, other HIV-1 clades are increasingly identified, especially in the group of subjects infected recently. An HIV transmission cluster, associated to injecting drug use was identified by phylogenetic analysis. The overall prevalence of TDR was 14.75%, mainly associated with NRTI resistance (13.11%), TAMs and M184V being the most common mutations. A declining trend of TDR was recorded from 26.08% in 1997–2004 to 7.89% in 2005–2011. No primary resistance was identified among recent seroconvertors. All HIV-1 strains had minor mutations in the protease and RT genes, often detected at polymorphic positions. The declining rates of TDR might be related to the high efficacy of HAART and to the increasing number of treated patients with virological success who have a low risk of transmission. The recent increase of HIV-1 infections which involve other subtypes impose a continuous surveillance of the genetic composition of the epidemic.

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HIV-1 drug resistance in antiretroviral-naive individuals in sub-Saharan Africa after rollout of antiretroviral therapy: a multicentre observational study

Cited by 267 publications

References 33 publications

First and Second Line Highly Active Anti-Retroviral Therapy Failure in HIV Infected Nigerian Children at University of Abuja Teaching Hospital Gwagwalada, Nigeria

First and Second Line Highly Active Anti-Retroviral Therapy Failure in HIV Infected Nigerian Children at University of Abuja Teaching Hospital Gwagwalada, Nigeria

HIV‐1 drug resistance‐associated mutations among antiretroviral‐naive thai patients with chronic HIV‐1 infection

Transmitted HIV drug resistance in treatment‐naive Romanian patients

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