HIV Drug Resistance and Its Impact on Antiretroviral Therapy in Chinese HIV-Infected Patients

Abstract

BackgroundHighly active antiretroviral therapy (HAART) has significantly decreased mortality among Chinese HIV patients. However, emerging HIV drug resistance (HIVDR) poses a growing threat to the long-term success and durability of HAART.MethodsThree cross-sectional surveys were conducted across the country from 2004 to 2006, respectively. Patients completed a questionnaire and provided blood for CD4 cell count, HIV viral load (VL), and HIV resistance genotyping. Factors associated with HIVDR were identified by logistic regression.Results3667 unique patients were included across the three surveys. Among 2826 treatment-experienced patients, median duration of treatment was 17.4 (IQR 8.6–28.4) months and HIVDR was identified in 543 (19.2%). Factors significantly associated with HIVDR included ART drug distribution location, CD4 cell count, initial HAART regimen, self-reported medication adherence, and province.ConclusionsVirologic failure increased over time on therapy but a significant proportion of patients in failure had no resistance mutations identified, suggesting that treatment adherence is suboptimal and must be emphasized. Due to the significantly higher risk of HIVDR in certain provinces, additional steps to reduce HIVDR should be taken.

Drug Resistance and Virological Failure among HIV-Infected Patients after a Decade of Antiretroviral Treatment Expansion in Eight Provinces of China

“…The first factor reflected that adherence was a direct factor causing HIVDR, with 21(2.7%) patients having reported to have lower than 90% of drug intake in the past month. Similar findings had been reported in our previous studies in China [19, 27, 30], where poor adherence clearly leads to the occurrence of HIVDR. Good adherence can suppress plasma HIV RNA and utilize the optimum effectiveness of the ART therapy.…”

Strengthening HIV therapy and care in rural Tanzania affects rates of viral suppression

“…30 Our findings are in agreement with the WHO recommendations for HIV viral load testing in resource-limited settings, which suggest that patients with low viraemia should undergo intensified adherence interventions to regain HIV-1 RNA suppression without switching ART, 31 and those with repeated high viral load measures should be switched to second-line ART without delay. 32,33 Interestingly, we did not detect the K65R mutation, which reduces the susceptibility to tenofovir disoproxil fumarate, despite the fact that one-third of patients with detectable HIV-DRM had been on a tenofovir-based regimen for a minimum of 6 months. K65R is the most important discriminatory mutation, causing intermediate resistance to tenofovir, while increasing the susceptibility to zidovudine, and is mostly selected in patients with HIV subtype C. 34 Our observation provides relevant preliminary information on the mutational patterns among patients under the current WHO guideline recommendations for tenofovir-based regimens.…”

Improving Adherence to Antiretroviral Therapy With Triggered Real-time Text Message Reminders

“…25,29–31 China’s government scaled up free provision of ART beginning in 2003, 32,33 and has reported 140,000 individuals receiving ART by 2012. 25 Drug resistance is emerging as a problem, indicating widespread sub-optimal adherence, 34–36 yet few adherence interventions have been studied in China. Two exceptions include a nurse-delivered counseling intervention conducted in Beijing, which showed positive effects of counseling and reminders, 37 and our own past work in the heavily-impacted border province of Yunnan, the “Adherence for Life” (AFL) study.…”