Performance of a World Health Organization first‐line regimen (stavudine/lamivudine/nevirapine) in antiretroviral‐naïve individuals in a Western setting

Tam, Lily W Y; Hogg, Robert S.; Yip, Benita; Montaner, Julio S. G.; Harrigan, P. Richard; Brumme, Chanson J.

doi:10.1111/j.1468-1293.2007.00463.x

Cited by 11 publications

(9 citation statements)

References 9 publications

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“…An early study from Senegal showed that 12.5% had one or more drug resistance mutations after a median of 30 months on ART [26], whereas a recent study from Côte d'Ivoire found 22% resistance after a median of 37 months on ART [27]. These results should not be used as an argument against HIV treatment in Africa; in fact, the results are comparable to a recent study from Canada, where 20% developed resistance after 30 months on the ART regimen most widely used in resource-limited settings (stavudine/lamivudine/nevirapine) [28]. Thus, emergence of drug resistance appears to occur at a similar rate in Africa as in a Western setting.…”

Section: Discussionmentioning

confidence: 83%

Virological efficacy and emergence of drug resistance in adults on antiretroviral treatment in rural Tanzania

et al. 2009

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BackgroundVirological response to antiretroviral treatment (ART) in rural Africa is poorly described. We examined virological efficacy and emergence of drug resistance in adults receiving first-line ART for up to 4 years in rural Tanzania.MethodsHaydom Lutheran Hospital has provided ART to HIV-infected patients since October 2003. A combination of stavudine or zidovudine with lamivudine and either nevirapine or efavirenz is the standard first-line regimen. Nested in a longitudinal cohort study of patients consecutively starting ART, we carried out a cross-sectional virological efficacy survey between November 2007 and June 2008. HIV viral load was measured in all adults who had completed at least 6 months first-line ART, and genotypic resistance was determined in patients with viral load >1000 copies/mL.ResultsVirological response was measured in 212 patients, of whom 158 (74.5%) were women, and median age was 35 years (interquartile range [IQR] 29–43). Median follow-up time was 22.3 months (IQR 14.0–29.9). Virological suppression, defined as <400 copies/mL, was observed in 187 patients (88.2%). Overall, prevalence of ≥1 clinically significant resistance mutation was 3.9, 8.4, 16.7 and 12.5% in patients receiving ART for 1, 2, 3 and 4 years, respectively. Among those successfully genotyped, the most frequent mutations were M184I/V (64%), conferring resistance to lamivudine, and K103N (27%), Y181C (27%) and G190A (27%), conferring resistance to non-nucleoside reverse transcriptase inhibitors (NNRTIs), whereas 23% had thymidine analogue mutations (TAMs), associated with cross-resistance to all nucleoside reverse transcriptase inhibitors (NRTIs). Dual-class resistance, i.e. resistance to both NRTIs and NNRTIs, was found in 64%.ConclusionVirological suppression rates were good up to 4 years after initiating ART in a rural Tanzanian hospital. However, drug resistance increased with time, and dual-class resistance was common, raising concerns about exhaustion of future antiretroviral drug options. This study might provide a useful forecast of drug resistance and demand for second-line antiretroviral drugs in rural Africa in the coming years.

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Section: Discussionmentioning

confidence: 83%

Virological efficacy and emergence of drug resistance in adults on antiretroviral treatment in rural Tanzania

et al. 2009

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“…In a recent analysis, an appreciable percentage of patients accumulated drug resistance or required second-line treatment relatively soon after the start of first-line ART with stavudine, lamivudine, and nevirapine [3]. Similar studies of patients receiving first-line ART in Africa and Thailand showed a high rate of TAM accumulation in patients with immunological or clinical failure in response to WHO-recommended treatments [4][5][6][7][8][9][10][11].…”

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confidence: 96%

Rate of Accumulation of Thymidine Analogue Mutations in Patients Continuing to Receive Virologically Failing Regimens Containing Zidovudine or Stavudine: Implications for Antiretroviral Therapy Programs in Resource‐Limited Settings

Cozzi‐Lepri¹,

Phillips²,

Martínez-Picado³

et al. 2009

J INFECT DIS

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“…29-31 With the evolving HIV-1 epidemic in China, it becomes necessary to monitor HIV-1 resistant variants to antiretroviral agents in newly infected individuals. 27, 32, 33 …”

Section: Discussionmentioning

confidence: 99%

Prevalence of Drug-Resistant HIV-1 in Rural Areas of Hubei Province in the People's Republic of China

Luo¹,

Liu²,

Zhuang³

et al. 2009

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Objective To determine the prevalence of drug resistant HIV-1 and the efficacy of first-line HAART regimens consisted of generic NRTI and NNRTI among 339 study subjects in rural areas of Hubei province, China. Methods Two cross-sectional studies were conducted to investigate 150 HAART-naïve (99 received subsequent therapy) between 2003 and 2005 and 288 HAART-experienced patients mainly between 2005 and 2006. Patients’ CD4+ T cell count and viral load were determined. HIV-1 pol gene fragments were amplified from patients’ plasma by RT-PCR, subsequently sequenced and analyzed. Results 83.5% of the patients were from rural villages. They were dominantly infected with subtype B’ HIV-1 (96.7%) through paid blood donation (64.6%) and related blood transfusion (28.3%). We found that there was a steady increase of CD4 count over time among treated patients without detectable viral load (186/288, 64.6%). There was, however, an increasing prevalence of NRTI and NNRTI resistant mutations among patients with detected viremia (102/288, 35.4%) after treatment for 3-6 (24.3%), 9-12 (57.1%) and 20-24 (63.3%) months, respectively. The increasing rates were associated with significant CD4 count drop and viral load increase. Some patients also developed multi-drug resistant mutants. Conclusions We report the first HIV-1 drug resistance study after two-years on HAART among Chinese patients living in rural villages. Our data suggest that a significant portion of patients are failing first-line regimens with a trend of AIDS progression. It is therefore necessary to maximize the drug adherence and to make affordable second-line HAART regimens available immediately. Our results have implications for implementing HAART in under-resourced developing country settings.

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Performance of a World Health Organization first‐line regimen (stavudine/lamivudine/nevirapine) in antiretroviral‐naïve individuals in a Western setting

Cited by 11 publications

References 9 publications

Virological efficacy and emergence of drug resistance in adults on antiretroviral treatment in rural Tanzania

Virological efficacy and emergence of drug resistance in adults on antiretroviral treatment in rural Tanzania

Rate of Accumulation of Thymidine Analogue Mutations in Patients Continuing to Receive Virologically Failing Regimens Containing Zidovudine or Stavudine: Implications for Antiretroviral Therapy Programs in Resource‐Limited Settings

Prevalence of Drug-Resistant HIV-1 in Rural Areas of Hubei Province in the People's Republic of China

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