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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Emergence of HIV drug resistance during first- and second-line antiretroviral therapy in resource-limited settings
Journal of Infectious Diseases, Volume 207, No. SUPPL.2, Year 2013
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Description
IntroductionAntiretroviral therapy (ART) in resource-limited settings has expanded in the last decade, reaching >8 million individuals and reducing AIDS mortality and morbidity. Continued success of ART programs will require understanding the emergence of HIV drug resistance patterns among individuals in whom treatment has failed and managing ART from both an individual and public health perspective. We review data on the emergence of HIV drug resistance among individuals in whom first-line therapy has failed and clinical and resistance outcomes of those receiving second-line therapy in resource-limited settings.ResultsResistance surveys among patients initiating first-line nonnucleoside reverse-transcriptase inhibitor (NNRTI)-based therapy suggest that 76%-90% of living patients achieve HIV RNA suppression by 12 months after ART initiation. Among patients with detectable HIV RNA at 12 months, HIV drug resistance, primarily due to M184V and NNRTI mutations, has been identified in 60%-72%, although the antiretroviral activity of proposed second-line regimens has been preserved. Complex mutation patterns, including thymidine-analog mutations, K65R, and multinucleoside mutations, are prevalent among cases of treatment failure identified by clinical or immunologic methods. Approximately 22% of patients receiving second-line therapy do not achieve HIV RNA suppression by 6 months, with poor adherence, rather than HIV drug resistance, driving most failures. Major protease inhibitor resistance at the time of second-line failure ranges from 0% to 50%, but studies are limited.ConclusionsResistance of HIV to first-line therapy is predictable at 12 months when evaluated by means of HIV RNA monitoring and, when detected, largely preserves second-line therapy options. Optimizing adherence, performing resistance surveillance, and improving treatment monitoring are critical for long-term prevention of drug resistance. © The Author 2013. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.
Authors & Co-Authors
Hosseinipour, Mina C.
Malawi, Lilongwe
Unc Project-malawi
United States, Chapel Hill
Unc School of Medicine
Gupta, Ravindra K.
United Kingdom, London
Ucl Medical School
Van Zyl, Gert Uves
South Africa, Stellenbosch
Stellenbosch University
Eron, Joseph J.
United States, Chapel Hill
Unc School of Medicine
Nachega, J. B.
South Africa, Cape Town
Stellenbosch University, Faculty of Medicine and Health Sciences
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
United States, Pittsburgh
Graduate School of Public Health
Statistics
Citations: 136
Authors: 5
Affiliations: 7
Identifiers
Doi:
10.1093/infdis/jit107
ISSN:
00221899
Research Areas
Cancer
Infectious Diseases
Study Design
Cross Sectional Study