Prevalence of Antiretroviral Drug Resistance in Patients Who Are Not Responding to Protease Inhibitor–Based Treatment: Results From the First National Survey in South Africa

Abstract

Limited data exist on human immunodeficiency virus type 1 (HIV-1) resistance in patients who are not responding to protease inhibitor (PI)-based regimens in resource-limited settings. This study assessed resistance profiles in adults across South Africa who were not responding to PI-based regimens. pol sequencing was undertaken and submitted to the Stanford HIV Drug Resistance Database. At least 1 major PI mutation was detected in 16.4% of 350 participants. A total of 53.4% showed intermediate resistance to darunavir/ritonavir, whereas high-level resistance was not observed. Only 5.2% and 32.8% of participants showed high-level and intermediate resistance to etravirine, respectively. Although the prevalence of major PI mutations was within previously reported ranges, most patients will likely experience virological suppression during receipt of currently available South African third-line regimens.

Third-Line Antiretroviral Therapy Program in the South African Public Sector: Cohort Description and Virological Outcomes

“…23–25 Most patients who are not virologically suppressed on second-line ART in resource-limited settings do not have PI resistance mutations and are therefore failing as a result of poor adherence to ART. 26–31…”

A Clinical Prediction Rule for Protease Inhibitor Resistance in Patients Failing Second-Line Antiretroviral Therapy

“…The proportion of patients failing second-line ART with PI resistance that we found is higher than previously described in the South African public sector. 2,3,5,6,16 The high proportion of patients with PI resistance that we observed may in part be due to the prolonged exposure to PIs in this cohort, as the AfA program started providing ART several years before the inception of the South African public sector ART program. In addition, there may be some selection bias, as patients known to be poorly adherent may have been denied preauthorization of GART by AfA.…”

Análisis genético de las mutaciones presentes en las poblaciones virales en pacientes con infección por VIH-1 en Ecuador

“…Los elevados niveles de resistencia a IP y a ITR-NAN, pudieran corresponder a la alta sensibilidad de la pirosecuenciación para las poblaciones minoritarias virales, a tratamientos ARV de larga duración con estos medicamentos o a la falta de adherencia adecuada con los ARV 20 . Las razones más comunes del fallo virológico en pacientes con tratamientos ARV son la adherencia inadecuada a los medicamentos, la infección con otra cepa viral, la inestabilidad en el acceso a algunos medicamentos, la supresión virológica incompleta en pacientes tratados con medicamentos de baja barrera genética, los factores farmacocinéticos y la transmisión de variantes minoritarias resistentes en pacientes con fallo a la terapia de primera línea 21 .…”