Virological Outcomes and Drug Resistance in Chinese Patients after 12 Months of 3TC-Based First-Line Antiretroviral Treatment, 2011–2012

Wang, Jing; He, Cui; Hsi, Jenny H.; Xu, Xun; Liu, Yong; He, Jianmei; Ling, Hua; Ding, Ping; Tong, Yi Fan; Zou, Xiaobai; Zhou, Quan; Liao, Lingjie; Wang, Xia; Ruan, Yuhua; Shao, Yiming; Xing, Hui

doi:10.1371/journal.pone.0088305

Cited by 22 publications

(25 citation statements)

References 32 publications

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“…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.…”

Section: Discussionsupporting

confidence: 92%

“…Our findings showed that 91.5% (700/765) achieved virological suppression (VL<1000 copies/ml) after 13.9 months of ART, which is better than the outcomes of previous surveillance studies in China [19–21]. 33 patients (4.3%) had verified HIVDR which is slightly lower than other countries where national free ART is available.…”

Section: Discussioncontrasting

confidence: 74%

“…A combination of strategies is required to combat drug resistance. New medicines that can more robustly cope with drug resistance mutants are needed, especially for those with common mutations such as K103N and M184I/ V [19, 26, 27]. M184I/V confers resistance to lamivudine, which is often the first mutation to develop in patients receiving partially suppressive triple combination therapy including lamivudine [28].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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BackgroundChina’s National Free Antiretroviral Treatment Program (NFATP) has substantially increased the survival rate since 2002. However, the emergence of HIV drug resistance (HIVDR) limits the durability and effectiveness of antiretroviral treatment (ART) in at risk patients.MethodA cross-sectional survey was conducted among patients having received a median of 13.9 months of ART in eight provinces in China. Demographic and clinical information was collected, and venous blood was sampled for CD4 cell counts, measurement of the HIV viral load (VL), and HIV drug resistance (HIVDR) genotyping. Possible risk factors for HIVDR were analyzed by the logistic regression model.ResultsThe study included 765 patients. Among them, 65 patients (8.5%) had virological failure (VLF) defined as ≥1,000 copies/ml. Among the individuals with VLF, 64 were successful genotyped, and of these, 33 had one or more HIVDR mutations. The prevalence of HIVDR mutations among patients receiving first-line ART was 4.3% (33/765). All of the patients with HIVDR mutations were resistant to non-nucleoside transcriptase inhibitors, 81.8% were resistant to nucleoside reverse transcriptase inhibitors, and only 3% had mutations that caused resistance to protease inhibitors. Having lower ratios of drug intake in the past month and dwelling in two southwestern provinces were factors independently associated with the emergence of HIVDR.ConclusionMost patients receiving first-line ART treatment achieved sound virological and immunological outcomes. However, poor adherence is still a key problem, which has led to the high rate of HIVDR. It was notable that the proportion of drug resistance widely varied among the provinces. More studies are needed to focus on adherence.

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Section: Discussionsupporting

confidence: 92%

Section: Discussioncontrasting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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“…In the sensitivity analysis, however, a second confirmatory testing was not required. The number of virological failures in this sensitivity analysis was increased which resulted in high CD4 count having a protective effect over treatment failure consistent with previous studies .…”

Section: Discussionsupporting

confidence: 82%

Effects of unplanned treatment interruptions on HIV treatment failure – results from TAHOD

Jiamsakul¹,

Kerr²,

et al. 2016

Tropical Med Int Health

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Objectives Treatment interruptions (TI) of combination antiretroviral therapy (cART) are known to lead to unfavourable treatment outcomes but do still occur in resource-limited settings. We investigated the effects of TI associated with adverse events (AEs) and non-AE-related reasons, including their durations, on treatment failure after cART resumption in HIV-infected individuals in Asia. Methods Patients initiating cART between 2006-2013 were included. TI was defined as stopping cART for >1 day. Treatment failure was defined as confirmed virological, immunological or clinical failure. Time to treatment failure during cART was analysed using Cox regression, not including periods off treatment. Co-variables with p<0.10 in univariable analyses were included in multivariable analyses, where p<0.05 was considered statistically significant. Results Of 4549 patients from 13 countries in Asia, 3176 (69.8%) were male and the median age was 34 years. A total of 111 (2.4%) had TIs due to AEs and 135 (3.0%) had TIs for other reasons. Median interruption times were 22 days for AE and 148 days for non-AE TIs. In multivariable analyses, interruptions >30 days were associated with failure (31-180 days HR=2.66, 95%CI (1.70-4.16); 181-365 days HR=6.22, 95%CI (3.26-11.86); and >365 days HR=9.10, 95% CI (4.27-19.38), all p<0.001, compared to 0-14 days). Reasons for previous TI were not statistically significant (p=0.158). Conclusions Duration of interruptions of more than 30 days was the key factor associated with large increases in subsequent risk of treatment failure. If TI is unavoidable, its duration should be minimised to reduce the risk of failure after treatment resumption.

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“…In this study, the annual ADR rate was lower than the threshold low-incidence rate defined by WHO of 5% [17] due to the expansion of National Free Antiretroviral Treatment Program (NFATP) in Hunan Province in recent years. Early antiviral treatment can control virus replication as early as possible, and reduce the possibility of drug resistance [13,18]. The result showed that CRF01 AE is still the most dominance subtype in Hunan province (64.14%), followed by subtype BC,B and C, the finding corresponding to the last years of the Hunan Province molecular epidemiology survey (2009-2015) results [10][11][12]19]..…”

Section: Discussionmentioning

confidence: 99%

Prevalence of acquired drug resistance mutations in antiretroviral- experiencing subjects from 2012 to 2017 in Hunan Province of central South China

Zou

Zheng

et al. 2020

Virol J

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Background: There are few data on the prevalence of acquired drug resistance mutations (ADRs) in Hunan Province, China, that could affect the effectiveness of antiretroviral therapy (ART). Objectives: The main objectives of this study were to determine the prevalence of acquired drug resistance (ADR) the epidemic characteristics of HIV-1-resistant strains among ART-failed HIV patients in Hunan Province, China. Methods: ART-experienced and virus suppression failure subjects in Hunan between 2012 and 2017 were evaluated by genotyping analysis and mutations were scored using the HIVdb.stanford.edu algorithm to infer drug susceptibility. Results: The prevalence of HIV-1 ADR were 2.76, 2.30, 2.98, 2.62, 2.23and 2.17%, respectively, from 2012 to 2017. Overall 2295 sequences were completed from 2932 ART-failure patients, and 914 of these sequences were found to have drug resistance mutation. The most common subtype was AE (64.14%), followed by BC (17.91%) and B (11.50%). Among those 914 patients with drug resistance mutations,93.11% had NNRTI-associated drug resistance mutations, 74.40% had NRTI drug resistance mutations (DRMs) and 6.89% had PI DRMs. Dual-class mutations were observed in 591 (64.66%) cases, and triple-class mutations were observed in 43 (4.70%) cases. M184V (62.04%), K103N (41.90%) and I54L (3.83%) were the most common observed mutations, respectively, in NRTI-, NNRTI-and PIassociated drug resistance. 93.76% subjects who had DRMs received the ART first-line regimens. CD4 count, symptoms in the past 3 months, and ART adherence were found to be associated with HIV-1 DR. Conclusions: This study showed that although the prevalence of HIV-acquired resistance in Hunan Province is at a low-level, the long-term and continuous surveillance of HIV ADR in antiretroviral drugs (ARVs) patients is necessary.

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Virological Outcomes and Drug Resistance in Chinese Patients after 12 Months of 3TC-Based First-Line Antiretroviral Treatment, 2011–2012

Cited by 22 publications

References 32 publications

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

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

Effects of unplanned treatment interruptions on HIV treatment failure – results from TAHOD

Prevalence of acquired drug resistance mutations in antiretroviral- experiencing subjects from 2012 to 2017 in Hunan Province of central South China

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