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Moderate levels of pre-therapy drug resistance (PDR) in a generalised epidemic: time for better first-line ART?
- Source :
-
AIDS (London, England) [AIDS] 2017 Nov; Vol. 31 (17), pp. 2387-2391. Date of Electronic Publication: 2017 Aug 28. - Publication Year :
- 2017
-
Abstract
- Background: The WHO-recommended first-line antiretroviral therapy (ART) as a fixed dose combination (FDC) of efavirenz (EFV) and tenofovir disoproxil fumarate (TDF) with lamivudine (3TC) or emtricitabine (FTC) has been preferred in the large scale unprecedented ART roll out in Southern Africa. Models and recent reports suggest that pre-ART HIV drug resistance (PDR) is increasing with high treatment coverage.<br />Method: We therefore investigated PDR and any local transmission clusters in a setting where high treatment coverage was further enhanced by universal test and treat (UTT). Surveillance drug resistance mutations (SDRMs) were identified with an in-house PCR and population sequencing method and calibrated population resistance (CPR) tool.<br />Results: Of 60 patients, six (10%) had an SDRM mutation: five (8.3%) had nonnucleoside reverse transcriptase (NNRT) mutations, one had an nucleos(t)ide reverse transcriptase inhibitor mutation and none had protease inhibitor (PI) mutations. Phylogenetic analysis revealed no large transmission clusters.<br />Conclusion: An increase to the current moderate PDR levels and the better tolerability and durability, may support a recent drive to avail FDC integrase strand transfer inhibitor (ISTI)-based regimens as the new preferred first-line ART in the Southern African region for individual benefit and to contribute to limiting transmission of infection and drug resistant virus.
- Subjects :
- Adolescent
Adult
Africa, Southern epidemiology
Anti-Retroviral Agents administration & dosage
Disease Transmission, Infectious
Female
Genotyping Techniques
HIV Infections drug therapy
HIV Infections transmission
Humans
Male
Microbial Sensitivity Tests
Middle Aged
Mutation
Polymerase Chain Reaction
Prevalence
Young Adult
Anti-Retroviral Agents pharmacology
Antiretroviral Therapy, Highly Active methods
Drug Resistance, Viral
Epidemics
HIV Infections epidemiology
HIV Infections virology
Subjects
Details
- Language :
- English
- ISSN :
- 1473-5571
- Volume :
- 31
- Issue :
- 17
- Database :
- MEDLINE
- Journal :
- AIDS (London, England)
- Publication Type :
- Academic Journal
- Accession number :
- 28857824
- Full Text :
- https://doi.org/10.1097/QAD.0000000000001629