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Juntit OA, Sornsuwan K, Wisitponchai T, Sanghiran Lee V, Sakkhachornphop S, Yasamut U, Tayapiwatana C. Dimeric Ankyrin with Inverted Module Promotes Bifunctional Property in Capturing Capsid to Impede HIV-1 Replication. Int J Mol Sci 2023; 24:ijms24065266. [PMID: 36982337 PMCID: PMC10048781 DOI: 10.3390/ijms24065266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 03/12/2023] Open
Abstract
Several anti-HIV scaffolds have been proposed as complementary treatments to highly active antiretroviral therapy. AnkGAG1D4, a designed ankyrin repeat protein, formerly demonstrated anti-HIV-1 replication by interfering with HIV-1 Gag polymerization. However, the improvement of the effectiveness was considered. Recently, the dimeric molecules of AnkGAG1D4 were accomplished in enhancing the binding activity against HIV-1 capsid (CAp24). In this study, the interaction of CAp24 against the dimer conformations was elucidated to elaborate the bifunctional property. The accessibility of the ankyrin binding domains was inspected by bio-layer interferometry. By inverting the second module of dimeric ankyrin (AnkGAG1D4NC-CN), the CAp24 interaction KD was significantly reduced. This reflects the capability of AnkGAG1D4NC-CN in simultaneously capturing CAp24. On the contrary, the binding activity of dimeric AnkGAG1D4NC-NC was indistinguishable from the monomeric AnkGAG1D4. The bifunctional property of AnkGAG1D4NC-CN was subsequently confirmed in the secondary reaction with additional p17p24. This data correlates with the MD simulation, which suggested the flexibility of the AnkGAG1D4NC-CN structure. The CAp24 capturing capacity was influenced by the distance of the AnkGAG1D4 binding domains to introduce the avidity mode of AnkGAG1D4NC-CN. Consequently, AnkGAG1D4NC-CN showed superior potency in interfering with HIV-1 NL4-3 WT and HIV-1 NL4-3 MIRCAI201V replication than AnkGAG1D4NC-NC and an affinity improved AnkGAG1D4-S45Y.
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Affiliation(s)
- On-anong Juntit
- Division of Clinical Immunology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand; (O.-a.J.); (K.S.); (T.W.); (U.Y.)
- Center of Biomolecular Therapy and Diagnostic, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Kanokporn Sornsuwan
- Division of Clinical Immunology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand; (O.-a.J.); (K.S.); (T.W.); (U.Y.)
- Center of Biomolecular Therapy and Diagnostic, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Tanchanok Wisitponchai
- Division of Clinical Immunology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand; (O.-a.J.); (K.S.); (T.W.); (U.Y.)
- Center of Biomolecular Therapy and Diagnostic, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Vannajan Sanghiran Lee
- Department of Chemistry, Drug Design Development Research Group, Center of Theoretical and Computational Physics, Faculty of Science, University of Malaya, Kuala Lumpur 50603, Malaysia;
| | | | - Umpa Yasamut
- Division of Clinical Immunology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand; (O.-a.J.); (K.S.); (T.W.); (U.Y.)
- Center of Biomolecular Therapy and Diagnostic, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand
- Center of Innovative Immunodiagnostic Development, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Chatchai Tayapiwatana
- Division of Clinical Immunology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand; (O.-a.J.); (K.S.); (T.W.); (U.Y.)
- Center of Biomolecular Therapy and Diagnostic, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand
- Center of Innovative Immunodiagnostic Development, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand
- Correspondence: ; Tel.: +66-8-1-8845141; Fax: +66-53-946042
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Johnson AM. Pandemic HIV and its legacy for medicine and global health. Clin Med (Lond) 2023; 23:106-114. [PMID: 36921987 PMCID: PMC11046497 DOI: 10.7861/clinmed.ed.23.2.harv] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
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Chen M, Wu M, Zeng L, Zhang Y, Huobu-Mo M, Li J, Li C, Xiao H. Virologic status and pattern of drug resistance mutation among ART-experienced HIV-infected patients in Butuo County, China. J Glob Antimicrob Resist 2023; 32:98-103. [PMID: 36708768 DOI: 10.1016/j.jgar.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 10/21/2022] [Accepted: 01/05/2023] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES To assess the virological outcomes, prevalence of HIV drug resistance mutation (DRM), and correlates in Butuo County. METHODS We conducted a cross-sectional study. Virological failure (VF) was defined as HIV-1 RNA ≥1000 copies/mL and on antiretroviral therapy (ART) for ≥6 months. Genotypic drug resistance was performed among VF cases. Correlates of DRM were identified using multivariate logistic regression. RESULTS The overall virological suppression rate was 85.3%; DRM was detected in 42.6% (517/1215) VF cases and 6.2% of the sample patients. A total of 90.9% of patients were infected with HIV-1 CRF07_BC subtype. The prevalence of DRM to nucleoside reverse transcriptase inhibitor (NRTI) and non-nucleoside reverse transcriptase inhibitor (NNRTI) were 46.0% and 96.9%, respectively. The most prevalent mutation for NRTI was M184V (84.5%). Lamivudine (3TC), emtricitabine (FTC), and abacavir (ABC) had the highest resistance rates. For NNRTI, K103N (60.7%), nevirapine (NVP), and efavirenz (EFV) had the highest resistance rates and cross resistance to rilpivirine (RPV), doravirine (DOR), and etravirine (ETR). Ritonavir boosted lopinavir (LPV/r) resistance rate was extremely low. The occurrence of DRM was associated with age at ART ≤18 years, baseline CD4 count ≤200 cells/mL, NVP-based regimen, and ART duration >3 years. CONCLUSION A relatively high proportion of VF and broad DRM for NRTI and NNRTI were observed, causing high-level resistance to first-line NRTI, NNRTI, and next generation NNRTI. Our findings necessitate the implementation of scaling up virological monitoring, adherence support, and timely switching to an LPV/r-containing regimen when patients with VF to reduce the occurrence of DRM.
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Affiliation(s)
- Minghong Chen
- Department of Infectious Diseases, Butuo People's Hospital, Butuo, Liangshan Prefecture, China
| | - Min Wu
- Antiviral Treatment Center, Butuo People's Hospital, Butuo, Liangshan Prefecture, China
| | - Liyan Zeng
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yong Zhang
- Department of Chronic Infectious Diseases Prevention and Treatment, Jiading District Center for Disease Control and Prevention, Shanghai, China
| | - Muzuo Huobu-Mo
- Antiviral Treatment Center, Butuo People's Hospital, Butuo, Liangshan Prefecture, China
| | - Juhua Li
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Chaoqun Li
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Hong Xiao
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
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HIV Drug Resistance in Adults Initiating or Reinitiating Antiretroviral Therapy in Uruguay-Results of a Nationally Representative Survey, 2018-2019. Viruses 2023; 15:v15020490. [PMID: 36851704 PMCID: PMC9961578 DOI: 10.3390/v15020490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/12/2023] Open
Abstract
The first nationally representative cross-sectional HIV drug resistance (HIVDR) survey was conducted in Uruguay in 2018-2019 among adults diagnosed with HIV and initiating or reinitiating antiretroviral therapy (ART). Protease, reverse transcriptase, and integrase genes of HIV-1 were sequenced. A total of 206 participants were enrolled in the survey; 63.2% were men, 85.7% were >25 years of age, and 35.6% reported previous exposure to antiretroviral (ARV) drugs. The prevalence of HIVDR to efavirenz or nevirapine was significantly higher (OR: 1.82, p < 0.001) in adults with previous ARV drug exposure (20.3%, 95% CI: 18.7-22.0%) compared to adults without previous ARV drug exposure (12.3%, 11.0-13.8%). HIVDR to any nucleoside reverse transcriptase inhibitors was 10.3% (9.4-11.2%). HIVDR to ritonavir-boosted protease inhibitors was 1.5% (1.1-2.1%); resistance to ritonavir-boosted darunavir was 0.9% (0.4-2.1%) among adults without previous ARV drug exposure and it was not observed among adults with previous ARV drug exposure. Resistance to integrase inhibitors was 12.7% (11.7-13.8%), yet HIVDR to dolutegravir, bictegravir, and cabotegravir was not observed. The high level (>10%) of HIVDR to efavirenz highlights the need to accelerate the transition to the WHO-recommended dolutegravir-based ART. Access to dolutegravir-based ART should be prioritised for people reporting previous ARV drug exposure.
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Su Y, Qi M, Zhong M, Yu N, Chen C, Ye Z, Cheng C, Hu Z, Zhang H, Wei H. Prevalence of HIV Transmitted Drug Resistance in Nanjing from 2018 to 2021. Infect Drug Resist 2023; 16:735-745. [PMID: 36756611 PMCID: PMC9901445 DOI: 10.2147/idr.s391296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/16/2022] [Indexed: 02/05/2023] Open
Abstract
Background Transmitted drug resistance (TDR) is a major challenge in the clinical management of acquired immunodeficiency syndrome (AIDS). Therefore, this study aimed to investigate the epidemic characteristics of and risk factors for human immunodeficiency virus (HIV)-1 TDR in Nanjing from 2018 to 2021 to provide support for clinical management. Methods The HIV-1 Pol gene was amplified by nested reverse transcription polymerase chain reaction from venous blood of 1190 HIV-infected patients who did not receive antiviral therapy, and the amplified product was sequenced using an in-house sequencing method. The sequencing result was compared with the HIV drug resistance database from Stanford University to elucidate the rates of antiviral drug resistance and distribution of drug-resistant mutation sites. Factors associated with TDR were evaluated using a logistic regression model. Results Detection of drug resistance at the gene level was successful in 1138 of 1190 HIV-1-infected patients (95.6%), and the overall 4-year drug resistance rate was 8.2% (93/1138). The drug resistance rate was higher for non-nucleoside reverse transcriptase inhibitors (NNRTIs; 6.7%) than for nucleoside reverse transcriptase inhibitors (NRTIs; 2.5%) or protease inhibitors (PIs; 0.1%) (χ 2 = 83.907, P<0.0001). The most common NNRTI-related mutation was V179D/E followed by K103N. M184V was the dominant NRTI-associated mutation, and M46L/I was the most prevalent PI-associated mutation. A CD4+ T cell count of <50 cells/μL was significantly associated with an increased risk of TDR (OR=3.62, 95% CI: 1.38-9.51, P=0.009). Conclusion The prevalence of TDR in the city of Nanjing from 2018 to 2021 was at a moderate epidemic risk according to World Health Organization standards. Continuous monitoring of TDR can inform clinical diagnosis and treatment. Patients with advanced disease and a low CD4+ T lymphocyte count are more likely to have TDR in Nanjing.
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Affiliation(s)
- Yifan Su
- Department of Infectious Disease, The Second Hospital of Nanjing Affiliated to Nanjing University of Chinese Medicine, Nanjing, People’s Republic of China
| | - Mingxue Qi
- Department of Infectious Disease, The Second Hospital of Nanjing Affiliated to Nanjing University of Chinese Medicine, Nanjing, People’s Republic of China
| | - Mingli Zhong
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Nawei Yu
- Department of Infectious Disease, The Second Hospital of Nanjing Affiliated to Nanjing University of Chinese Medicine, Nanjing, People’s Republic of China
| | - Chen Chen
- Department of Infectious Disease, The Second Hospital of Nanjing Affiliated to Nanjing University of Chinese Medicine, Nanjing, People’s Republic of China
| | - Zi Ye
- Department of Infectious Disease, The Second Hospital of Nanjing Affiliated to Nanjing University of Chinese Medicine, Nanjing, People’s Republic of China
| | - Cong Cheng
- Department of Infectious Disease, The Second Hospital of Nanjing Affiliated to Nanjing University of Chinese Medicine, Nanjing, People’s Republic of China
| | - Zhiliang Hu
- Department of Infectious Disease, The Second Hospital of Nanjing Affiliated to Nanjing University of Chinese Medicine, Nanjing, People’s Republic of China
| | - Hongying Zhang
- Nanjing Center for Disease Control and Prevention Affiliated with Nanjing Medical University, Nanjing, People’s Republic of China,Hongying Zhang, Email
| | - Hongxia Wei
- Department of Infectious Disease, The Second Hospital of Nanjing Affiliated to Nanjing University of Chinese Medicine, Nanjing, People’s Republic of China,Correspondence: Hongxia Wei, Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, 210003, People’s Republic of China, Email
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Aliyu GG, Lawton JG, Mitchell AB, Abimiku AG, Jelpe T, Bassey O, Riedel DJ, Swaminathan M, Chang JCW, DeVos JR, Patel H, Charurat ME, Stafford KA. Prevalence of HIV drug resistance in Nigeria: results from a cross-sectional, population-based survey of Nigerian adults with unsuppressed viral load. AIDS 2023; 37:333-339. [PMID: 36541644 PMCID: PMC11167453 DOI: 10.1097/qad.0000000000003413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND HIV drug resistance (HIVDR) surveillance is an important tool to monitor threats to progress towards epidemic control. The characterization of HIVDR in Nigeria at the national level is needed to inform both clinical decisions and population-level HIV policy strategies. This study uses data obtained from the Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) to describe the prevalence and distribution of HIVDR in Nigeria. METHODS NAIIS was a cross-sectional, population-based survey of households throughout Nigeria in 2018. NAIIS was designed to provide estimates of HIV prevalence and related health indicators from a nationally representative sample. The study population included participants aged 15-64 years who tested positive for HIV, had a viral load at least 1000 copies/ml, and had available HIV drug resistance genotypes. HIV isolates were genotyped to detect drug resistance mutations. Individual characteristics of study participants associated with HIVDR were identified using a weighted multivariable logistic regression model. RESULTS Of 1355 respondents with available HIV genotypes, 293 (19%) had evidence of drug-resistant mutations (DRMs) that conferred resistance to at least one antiretroviral drug. The majority of DRMs observed conferred resistance to NNRTIs (17.6%) and NRTIs (11.2%). HIVDR was associated with being ART-experienced, longer duration on ART, and lower CD4+ count but not sociodemographic characteristics. CONCLUSION The population level DRM prevalence in Nigeria was consistent with what would be expected in a mature HIV treatment landscape. The continued roll out of dolutegravir-anchored regimens should mitigate the impact of NNRTI resistance on population viral load suppression and progress towards epidemic control.
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Affiliation(s)
| | - Jonathan G. Lawton
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrew B. Mitchell
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Alash’le G. Abimiku
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
- Institute of Human Virology-Nigeria, Abuja, Nigeria
| | - Tapdiyel Jelpe
- Centers for Disease Control and Prevention, Department of Global Health, Division of Global HIV & TB, Abuja, Nigeria
| | - Orji Bassey
- Centers for Disease Control and Prevention, Department of Global Health, Division of Global HIV & TB, Abuja, Nigeria
| | - David J. Riedel
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mahesh Swaminathan
- Centers for Disease Control and Prevention, Department of Global Health, Division of Global HIV & TB, Abuja, Nigeria
| | - Joy Chih-Wei Chang
- Centers for Disease Control and Prevention, Department of Global Health, International Laboratories Branch, Atlanta, USA
| | - Joshua R. DeVos
- Centers for Disease Control and Prevention, Department of Global Health, International Laboratories Branch, Atlanta, USA
| | - Hetal Patel
- Centers for Disease Control and Prevention, Department of Global Health, International Laboratories Branch, Atlanta, USA
| | - Man E. Charurat
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kristen A. Stafford
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
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Raymond S, Jeanne N, Nicot F, Dimeglio C, Carcenac R, Harter A, Ranger N, Martin-Blondel G, Delobel P, Izopet J. HIV-1 resistance genotyping by ultra-deep sequencing and 6-month virological response to first-line treatment. J Antimicrob Chemother 2023; 78:346-353. [PMID: 36449383 DOI: 10.1093/jac/dkac391] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/28/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To evaluate the routine use of the Sentosa ultra-deep sequencing (UDS) system for HIV-1 polymerase resistance genotyping in treatment-naïve individuals and to analyse the virological response (VR) to first-line antiretroviral treatment. METHODS HIV drug resistance was determined on 237 consecutive samples from treatment-naïve individuals using the Sentosa UDS platform with two mutation detection thresholds (3% and 20%). VR was defined as a plasma HIV-1 virus load <50 copies/mL after 6 months of treatment. RESULTS Resistance to at least one antiretroviral drug with a mutation threshold of 3% was identified in 29% and 16% of samples according to ANRS and Stanford algorithms, respectively. The ANRS algorithm also revealed reduced susceptibility to at least one protease inhibitor (PI) in 14.3% of samples, to one reverse transcriptase inhibitor in 12.7%, and to one integrase inhibitor (INSTI) in 5.1%. For a mutation threshold of 20%, resistance was identified in 24% and 13% of samples according to ANRS and Stanford algorithms, respectively. The 6 months VR was 87% and was similar in the 58% of patients given INSTI-based treatment, in the 16% given PI-based treatment and in the 9% given NNRTI-based treatment. Multivariate analysis indicated that the VR was correlated with the baseline HIV virus load and resistance to at least one PI at both 3% and 20% mutation detection thresholds (ANRS algorithm). CONCLUSIONS The Vela UDS platform is appropriate for determining antiretroviral resistance in patients on a first-line antiretroviral treatment. Further studies are needed on the use of UDS for therapeutic management.
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Affiliation(s)
- Stéphanie Raymond
- Toulouse Institute for Infectious and Inflammatory Diseases (INFINITy), INSERM UMR 1291 - CNRS UMR 5051, Toulouse, France.,CHU de Toulouse, Hôpital Purpan, Laboratoire de Virologie, Toulouse, F-31300France
| | - Nicolas Jeanne
- CHU de Toulouse, Hôpital Purpan, Laboratoire de Virologie, Toulouse, F-31300France
| | - Florence Nicot
- CHU de Toulouse, Hôpital Purpan, Laboratoire de Virologie, Toulouse, F-31300France
| | - Chloé Dimeglio
- CHU de Toulouse, Hôpital Purpan, Laboratoire de Virologie, Toulouse, F-31300France
| | - Romain Carcenac
- CHU de Toulouse, Hôpital Purpan, Laboratoire de Virologie, Toulouse, F-31300France
| | - Agnès Harter
- CHU de Toulouse, Hôpital Purpan, Laboratoire de Virologie, Toulouse, F-31300France
| | - Noémie Ranger
- CHU de Toulouse, Hôpital Purpan, Laboratoire de Virologie, Toulouse, F-31300France
| | - Guillaume Martin-Blondel
- Toulouse Institute for Infectious and Inflammatory Diseases (INFINITy), INSERM UMR 1291 - CNRS UMR 5051, Toulouse, France.,CHU de Toulouse, Hôpital Purpan, Service des Maladies Infectieuses et Tropicales, Toulouse, F-31300France
| | - Pierre Delobel
- Toulouse Institute for Infectious and Inflammatory Diseases (INFINITy), INSERM UMR 1291 - CNRS UMR 5051, Toulouse, France.,CHU de Toulouse, Hôpital Purpan, Service des Maladies Infectieuses et Tropicales, Toulouse, F-31300France
| | - Jacques Izopet
- Toulouse Institute for Infectious and Inflammatory Diseases (INFINITy), INSERM UMR 1291 - CNRS UMR 5051, Toulouse, France.,CHU de Toulouse, Hôpital Purpan, Laboratoire de Virologie, Toulouse, F-31300France
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Singsumran K, Sungkanuparph S. Long-term virological and immunological outcomes between HIV-positive individuals with and without pretreatment HIV drug resistance. Int J STD AIDS 2023; 34:322-327. [PMID: 36626357 DOI: 10.1177/09564624221149775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Pretreatment HIV drug resistance (PHDR) has emerged after scaling-up access to antiretroviral therapy (ART). This study aimed to compare long-term virological and immunological outcomes between HIV-positive individuals with and without PHDR. METHODS An observational cohort study was conducted in HIV-positive individuals who had a genotypic resistance test performed prior to ART initiation. RESULTS Of 335 participants, 39 were in the PHDR group and 296 were in the control group. ART regimen in PHDR group was adjusted at 6-10 weeks after ART initiation when results of baseline genotypic resistance test were available. Proportions of participants with undetectable viral load were significantly lower in PHDR group at 6 and 12 months (46.2% vs 79.4% (p < .001) and 74.4% vs 90.5% (p = .003), respectively). These virological responses became similar between two groups (p > .05) from 18 through 60 months. Mean change of CD4 counts of PHDR group was significantly lower only at 6 months (+59 vs + 81 cells/mm3 (p = .012); these immunological responses were similar between two groups from 12 through 60 months. CONCLUSION Early virological response was lower in HIV-positive participants with PHDR compared to participants without PHDR. Subsequent adjustment of ART according to pretreatment genotypic resistance has contributed to the long-term virological and immunological success that is similar to participants without PHDR.
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Affiliation(s)
- Kanokwan Singsumran
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Somnuek Sungkanuparph
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, 26685Mahidol University, Samut Prakan, Thailand
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Smith DM, Schafer JR, Tullius B, Witkam L, Paust S. Natural killer cells for antiviral therapy. Sci Transl Med 2023; 15:eabl5278. [PMID: 36599006 DOI: 10.1126/scitranslmed.abl5278] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Natural killer (NK) cell-based immunotherapy is being explored for treating infectious diseases, including viral infections. Here, we discuss evidence of NK cell responses to different viruses, ongoing clinical efforts to treat such infections with NK cell products, and review platforms to generate NK cell products.
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Affiliation(s)
- Davey M Smith
- Department of Medicine, University of California, San Diego, La Jolla, CA 92093, USA
| | | | | | - Laura Witkam
- Kiadis Pharma, Sanofi, 1105BP Amsterdam, Netherlands
| | - Silke Paust
- Department of Immunology and Microbiology, Scripps Research Institute, La Jolla, CA 92037, USA
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Shchemelev AN, Boumbaly S, Ostankova YV, Zueva EB, Semenov AV, Totolian AA. Prevalence of drug resistant HIV-1 forms in patients without any history of antiretroviral therapy in the Republic of Guinea. J Med Virol 2023; 95:e28184. [PMID: 36175006 DOI: 10.1002/jmv.28184] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 09/19/2022] [Accepted: 09/26/2022] [Indexed: 01/11/2023]
Abstract
To study the structure of human immunodeficiency virus (HIV)-1 drug resistance (DR) in patients with newly diagnosed infection. Residents of the Republic of Guinea (N = 2168) were tested for HIV using enzyme-linked immunosorbent assay (ELISA). Individuals with a positive result were further examined for the presence of viral load in blood plasma. HIV was analyzed using Sanger sequencing. The obtained sequences were genotyped using REGA (version 3.0) and analyzed in MEGA 7. Analysis for the presence of DR mutations was performed using the Stanford University HIV DR Database. Serological markers of HIV were detected in 239 people, which represents 11.02% of the entire sample. HIV RNA was detected in 58 people. The following subtypes were seen: HIV CRF02_AG (41.9%); A1 (29.1%); A3 (12.9%); URF A1_G (12.9%); and G (3.2%). In 25% of patients, at least one significant mutation was encountered leading directly to HIV DR. The mutations encountered cause resistance to NRTI and NNRTI; one case of multiple resistance was identified. Major resistance to protease inhibitor was not seen. The detection of HIV-1 mutations associated with DR, in individuals who have never received antiretroviral therapy, is a cause for concern. It suggests that: new infections are occurring with strains that already have resistance; and the expansion of resistance is not always directly associated with selective drug pressure. Among the likely reasons for the high prevalence of primary HIV DR in the Republic of Guinea, drug availability is probably the key. The consequence of this is the lack of adherence of patients to treatment, the formation and transmission of resistant variants of the virus in the population. These findings suggest the need to test patients for resistant virus variants before initiating treatment.
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Affiliation(s)
| | - Sanaba Boumbaly
- Institute Research Biology Appliquee De Guinee, Kindia, Republic of Guinea
| | | | - Elena B Zueva
- Saint Petersburg Pasteur Institute, St. Petersburg, Russia
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Venter P, van Onselen R. Evaluating the "wrong-way-round" electrospray ionization of antiretroviral drugs for improved detection sensitivity. Anal Bioanal Chem 2023; 415:1187-1193. [PMID: 36637494 PMCID: PMC9899738 DOI: 10.1007/s00216-022-04499-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/14/2022] [Accepted: 12/19/2022] [Indexed: 01/14/2023]
Abstract
The presence of antiretroviral drugs (ARVDs) in the aquatic environment poses a significant health risk to the ecosystem. The dilution of these compounds during wastewater treatment processes, followed by discharge into the environment, results in extremely low concentrations in the range of ng/L. Therefore, to enable detection of these low concentrations, it is important to determine the most efficient electrospray ionization (ESI) mode using the right mobile phase modifier and to establish a selective extraction procedure. In this study, we compared the ESI intensity in the positive and negative mode using both formic acid (FA) and ammonium hydroxide (NH4OH) as mobile phase modifiers. The results revealed a phenomenon known as the "wrong-way-round" (WWR) ESI in which high intensity [M + H]+ ions were detected under basic conditions using NH4OH as modifier and, similarly, high intensity [M-H]- ions were detected under acidic conditions using FA as modifier. Furthermore, mixed-mode strong cation (MCX) and mixed-mode strong anion (MAX) exchange sorbents were evaluated for extraction recoveries, which yielded extraction recoveries between 60 and 100%. Finally, the recoveries obtained using mixed-mode ion exchange sorbents compared to ion production during the ESI process provide evidence that ions produced in solution do not necessarily reflect the ions that are produced during the ESI process. Based on the results of this study, it is recommended to evaluate the optimal ionization mode under basic and acidic conditions, instead of defaulting to the use of acidic modifiers with positive ion detection.
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Affiliation(s)
- Pieter Venter
- grid.415021.30000 0000 9155 0024Biomedical Research and Innovation Platform, South African Medical Research Council, P.O. Box 19070, Tygerberg, 7505 South Africa
| | - Rianita van Onselen
- grid.415021.30000 0000 9155 0024Biomedical Research and Innovation Platform, South African Medical Research Council, P.O. Box 19070, Tygerberg, 7505 South Africa
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Sertoz R, Tekin D, Erensoy S, Biceroglu S, Kaptan F, Köse S, Ozkan H, Cetin B, Türken M, Gokengin D. Prevalence of Transmitted Drug Resistance among HIV-1 Patients in the Aegean Region: Results from the Western Part of Turkey. Curr HIV Res 2023; 21:109-116. [PMID: 37231747 DOI: 10.2174/1570162x21666230525145529] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVES This study aimed to analyze the antiretroviral drug resistance in antiretroviral treatment-naïve HIV-positive patients in the Aegean Region of Turkey from 2012 to 2019. METHODS The study included 814 plasma samples from treatment-naïve HIV-positive patients. Drug resistance analysis was performed by Sanger sequencing (SS) between 2012-2017 and by next-generation sequencing sequencing (NGS) between 2018-2019. SS was used to analyze resistance mutations in the protease (PR) and reverse transcriptase (RT) gene regions using a ViroSeq HIV-1 Genotyping System. PCR products were analyzed with an ABI3500 GeneticAnalyzer (Applied Biosystems). The sequencing of the HIV genome in the PR, RT, and integrase gene regions was carried out using MiSeq NGS technology. Drug resistance mutations and subtypes were interpreted using the Stanford University HIV-1 drug resistance database. RESULTS Transmitted drug resistance (TDR) mutation was detected in 34/814 (4.1 %) samples. Nonnucleoside reverse transcriptase inhibitor (NNRTI), nucleoside reverse transcriptase inhibitor (NRTI), and protease inhibitor (PI) mutations were identified in 1.4 % (n =12), 2.4 % (n =20), and 0.3 % (n = 3) of samples, respectively. The most common subtypes were B (53.1 %), A (10.9%), CRF29_BF (10.6%), and B + CRF02_AG (8,2%). The most common TDR mutations were E138A (3.4%), T215 revertants (1.7%), M41L (1.5%), and K103N (1.1%). CONCLUSION Transmitted drug resistance rate in the Aegean Region is compatible with national and regional data. Routine surveillance of resistance mutations may guide the safe and correct selection of initial drug combinations for antiretroviral therapy. The identification of HIV-1 subtypes and recombinant forms in Turkey may contribute to international molecular epidemiological data.
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Affiliation(s)
- Ruchan Sertoz
- Department of Medical Microbiology, Ege University Medical School, Izmir, Turkey
| | - Duygu Tekin
- Department of Medical Microbiology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Selda Erensoy
- Department of Medical Microbiology, Ege University Medical School, Izmir, Turkey
| | - Servet Biceroglu
- Department of Medical Microbiology, Ege University Medical School, Izmir, Turkey
| | - Figen Kaptan
- Department of Clinical Microbiology and Infectious Diseases, Atatürk Training and Research Hospital, Izmir, Turkey
| | - Sukran Köse
- Department of Clinical Microbiology and Infectious Diseases, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Hulya Ozkan
- Department of Clinical Microbiology and Infectious Diseases, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Banu Cetin
- Department of Clinical Microbiology and Infectious Diseases, Celal Bayar University Medical School, Izmir, Turkey
| | - Melda Türken
- Department of Clinical Microbiology and Infectious Diseases, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Deniz Gokengin
- Department of Clinical Microbiology and Infectious Diseases, Ege University Medical School, Izmir, Turkey
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Mengistu ST, Ghebremeskel GG, Achila OO, Abrehe MB, Tewelde SF, Idris MM, Tikue TG, Mesfin AB. Prevalence and factors associated with pediatric HIV therapy failure in a tertiary hospital in Asmara, Eritrea: A 15-year retrospective cohort study. PLoS One 2023; 18:e0282642. [PMID: 36893200 PMCID: PMC9997912 DOI: 10.1371/journal.pone.0282642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 02/20/2023] [Indexed: 03/10/2023] Open
Abstract
INTRODUCTION Treatment failure (TF) in HIV infected children is a major concern in resource-constrained settings in Sub-Saharan Africa (SSA). This study investigated the prevalence, incidence, and factors associated with first-line cART failure using the virologic (plasma viral load), immunologic and clinical criteria among HIV-infected children. METHODS A retrospective cohort study of children (<18 years of age on treatment for a period of > 6 months) enrolled in the pediatric HIV/AIDs treatment program at Orotta National Pediatric Referral Hospital from January 2005 to December 2020 was conducted. Data were summarized using percentages, medians (± interquartile range (IQR)), or mean ± standard deviation (SD). Where appropriate, Pearson Chi-Squire (χ2) tests or Fishers exacts test, Kaplan-Meier (KM) estimates, and unadjusted and adjusted Cox-proportional hazard regression models were employed. RESULTS Out of 724 children with at least 24 weeks' follow-up 279 experienced therapy failure (TF) making prevalence of 38.5% (95% CI 35-42.2) over a median follow-up of 72 months (IQR, 49-112 months), with a crude incidence of failure of 6.5 events per 100- person-years (95% CI 5.8-7.3). In the adjusted Cox proportional hazards model, independent factors of TF were suboptimal adherence (Adjusted Hazard Ratio (aHR) = 2.9, 95% CI 2.2-3.9, p < 0.001), cART backbone other than Zidovudine and Lamivudine (aHR = 1.6, 95% CI 1.1-2.2, p = 0.01), severe immunosuppression (aHR = 1.5, 95% CI 1-2.4, p = 0.04), wasting or weight for height z-score < -2 (aHR = 1.5, 95% CI 1.1-2.1, p = 0.02), late cART initiation calendar years (aHR = 1.15, 95% CI 1.1-1.3, p < 0.001), and older age at cART initiation (aHR = 1.01, 95% CI 1-1.02, p < 0.001). CONCLUSIONS Seven in one hundred children on first-line cART are likely to develop TF every year. To address this problem, access to viral load tests, adherence support, integration nutritional care into the clinic, and research on factors associated with suboptimal adherence should be prioritized.
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Affiliation(s)
- Samuel Tekle Mengistu
- Nakfa Hospital, Ministry of Health Northern Red Sea Branch, Nakfa, Eritrea
- Orotta School of Medicine, Orotta College of Medicine and Health Sciences, Asmara, Eritrea
- * E-mail:
| | - Ghirmay Ghebrekidan Ghebremeskel
- Nakfa Hospital, Ministry of Health Northern Red Sea Branch, Nakfa, Eritrea
- Orotta School of Medicine, Orotta College of Medicine and Health Sciences, Asmara, Eritrea
| | - Oliver Okoth Achila
- Department of Allied Health Sciences, Orotta College of Medicine and Health Sciences, Asmara, Eritrea
| | - Miriam Berhane Abrehe
- Department of Pediatrics and Child Health, Orotta National Referral and Teaching Hospital, Asmara, Eritrea
| | - Samuel Fisseha Tewelde
- Department of Pediatrics and Child Health, Orotta National Referral and Teaching Hospital, Asmara, Eritrea
| | - Mahmud Mohammed Idris
- Orotta School of Medicine, Orotta College of Medicine and Health Sciences, Asmara, Eritrea
- Department of Pediatrics and Child Health, Orotta National Referral and Teaching Hospital, Asmara, Eritrea
| | - Tsegereda Gebrehiwot Tikue
- Orotta School of Medicine, Orotta College of Medicine and Health Sciences, Asmara, Eritrea
- Department of Pediatrics and Child Health, Orotta National Referral and Teaching Hospital, Asmara, Eritrea
| | - Araia Berhane Mesfin
- National Communicable Disease Control Division, Ministry of Health, Asmara, Eritrea
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Petkov S, Kilpeläinen A, Bayurova E, Latanova A, Mezale D, Fridrihsone I, Starodubova E, Jansons J, Dudorova A, Gordeychuk I, Wahren B, Isaguliants M. HIV-1 Protease as DNA Immunogen against Drug Resistance in HIV-1 Infection: DNA Immunization with Drug Resistant HIV-1 Protease Protects Mice from Challenge with Protease-Expressing Cells. Cancers (Basel) 2022; 15:238. [PMID: 36612231 PMCID: PMC9818955 DOI: 10.3390/cancers15010238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/12/2022] [Accepted: 12/20/2022] [Indexed: 01/04/2023] Open
Abstract
DNA immunization with HIV-1 protease (PR) is advanced for immunotherapy of HIV-1 infection to reduce the number of infected cells producing drug-resistant virus. A consensus PR of the HIV-1 FSU_A strain was designed, expression-optimized, inactivated (D25N), and supplemented with drug resistance (DR) mutations M46I, I54V, and V82A common for FSU_A. PR variants with D25N/M46I/I54V (PR_Ai2mut) and with D25N/M46I/I54V/V82A (PR_Ai3mut) were cloned into the DNA vaccine vector pVAX1, and PR_Ai3mut, into a lentiviral vector for the transduction of murine mammary adenocarcinoma cells expressing luciferase 4T1luc2. BALB/c mice were DNA-immunized by intradermal injections of PR_Ai, PR_Ai2mut, PR_Ai3mut, vector pVAX1, or PBS with electroporation. All PR variants induced specific CD8+ T-cell responses revealed after splenocyte stimulation with PR-derived peptides. Splenocytes of mice DNA-immunized with PR_Ai and PR_Ai2mut were not activated by peptides carrying V82A, whereas splenocytes of PR_Ai3mut-immunized mice recognized both peptides with and without V82A mutation. Mutations M46I and I54V were immunologically silent. In the challenge study, DNA immunization with PR_Ai3mut protected mice from the outgrowth of subcutaneously implanted adenocarcinoma 4T1luc2 cells expressing PR_Ai3mut; a tumor was formed only in 1/10 implantation sites and no metastases were detected. Immunizations with other PR variants were not protective; all mice formed tumors and multiple metastasis in the lungs, liver, and spleen. CD8+ cells of PR_Ai3mut DNA-immunized mice exhibited strong IFN-γ/IL-2 responses against PR peptides, while the splenocytes of mice in other groups were nonresponsive. Thus, immunization with a DNA plasmid encoding inactive HIV-1 protease with DR mutations suppressed the growth and metastatic activity of tumor cells expressing PR identical to the one encoded by the immunogen. This demonstrates the capacity of T-cell response induced by DNA immunization to recognize single DR mutations, and supports the concept of the development of immunotherapies against drug resistance in HIV-1 infection. It also suggests that HIV-1-infected patients developing drug resistance may have a reduced natural immune response against DR HIV-1 mutations causing an immune escape.
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Affiliation(s)
- Stefan Petkov
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 171 65 Stockholm, Sweden
| | - Athina Kilpeläinen
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 171 65 Stockholm, Sweden
| | - Ekaterina Bayurova
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 171 65 Stockholm, Sweden
- Department of Research, Riga Stradins University, LV-1007 Riga, Latvia
- Chumakov Federal Scientific Center for Research and Development of Immune and Biological Products of Russian Academy of Sciences, 108819 Moscow, Russia
| | - Anastasia Latanova
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 171 65 Stockholm, Sweden
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia
| | - Dzeina Mezale
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 171 65 Stockholm, Sweden
- Department of Research, Riga Stradins University, LV-1007 Riga, Latvia
| | - Ilse Fridrihsone
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 171 65 Stockholm, Sweden
- Department of Research, Riga Stradins University, LV-1007 Riga, Latvia
| | - Elizaveta Starodubova
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 171 65 Stockholm, Sweden
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia
| | - Juris Jansons
- Department of Research, Riga Stradins University, LV-1007 Riga, Latvia
- Latvian Research and Study Centre, LV-1067 Riga, Latvia
| | - Alesja Dudorova
- Department of Research, Riga Stradins University, LV-1007 Riga, Latvia
- Paul Stradins University Hospital, LV-1002 Riga, Latvia
| | - Ilya Gordeychuk
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 171 65 Stockholm, Sweden
- Department of Research, Riga Stradins University, LV-1007 Riga, Latvia
- Chumakov Federal Scientific Center for Research and Development of Immune and Biological Products of Russian Academy of Sciences, 108819 Moscow, Russia
| | - Britta Wahren
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 171 65 Stockholm, Sweden
| | - Maria Isaguliants
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 171 65 Stockholm, Sweden
- Department of Research, Riga Stradins University, LV-1007 Riga, Latvia
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Akpan U, Nwanja E, Ukpong KA, Toyo O, Nwaokoro P, Sanwo O, Gana B, Badru T, Idemudia A, Pandey SR, Khamofu H, Bateganya M. Reaching Viral Suppression Among People With HIV With Suspected Treatment Failure who Received Enhanced Adherence Counseling in Southern Nigeria: A Retrospective Analysis. Open Forum Infect Dis 2022; 9:ofac651. [PMID: 36589481 PMCID: PMC9792083 DOI: 10.1093/ofid/ofac651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Indexed: 12/23/2022] Open
Abstract
Background This study assessed viral load (VL) testing and viral suppression following enhanced adherence counseling (EAC) among people with HIV (PWH) with suspected treatment failure and identified factors associated with persistent viremia. Methods We conducted a retrospective review of electronic medical records of PWH aged 15 years or older who had received antiretroviral therapy (ART) for at least 6 months as of December 2020 and had a high viral load (HVL; ≥1000 copies/mL) across 22 comprehensive HIV treatment facilities in Akwa Ibom State, Nigeria. Patients with HVL were expected to receive 3 EAC sessions delivered in person or virtually and repeat VL testing upon completion of EAC and after documented good adherence. At 6 months post-EAC enrollment, we reviewed the data to determine client uptake of 1 or more EAC sessions, completion of 3 EAC sessions, a repeat viral load (VL) test conducted post-EAC, and persistent viremia with a VL of ≥1000 copies/mL. Selected sociodemographic and clinical variables were analyzed to identify factors associated with persistent viremia using SPSS, version 26. Results Of the 3257 unsuppressed PWH, EAC uptake was 94.8% (n = 3088), EAC completion was 81.5% (2517/3088), post-EAC VL testing uptake was 75.9% (2344/3088), and viral resuppression was 73.8% (2280/3088). In multivariable analysis, those on ART for <12 months (P ≤ .001) and those who completed EAC within 3 months (P = .045) were less likely to have persistent viremia. Conclusions An HVL resuppression rate of 74% was achieved, but EAC completion was low. Identification of the challenges faced by PWH with a higher risk of persistent viremia is recommended to optimize the potential benefit of EAC.
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Affiliation(s)
- Uduak Akpan
- Correspondence: Uduak Akpan, 67, Bennett Bassey Street (Unit C), Ewet Housing Estate, Uyo, Akwa Ibom State, Nigeria ()
| | - Esther Nwanja
- Achieving Health Nigeria Initiative (AHNi), Akwa Ibom, Nigeria
| | | | - Otoyo Toyo
- Achieving Health Nigeria Initiative (AHNi), Akwa Ibom, Nigeria
| | | | | | - Bala Gana
- Achieving Health Nigeria Initiative (AHNi), Akwa Ibom, Nigeria
| | - Titilope Badru
- Achieving Health Nigeria Initiative (AHNi), Akwa Ibom, Nigeria
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Ntamatungiro AJ, Kagura J, Weisser M, Francis JM. Pre-treatment HIV-1 drug resistance in antiretroviral therapy-naive adults in Eastern Africa: a systematic review and meta-analysis. J Antimicrob Chemother 2022; 77:3231-3241. [PMID: 36225089 DOI: 10.1093/jac/dkac338] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/12/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Pre-treatment HIV drug resistance (PDR) may result in increased risk of virological failure and acquisition of new resistance mutations. With recently increasing ART coverage and periodic modifications of the guidelines for HIV treatment, there is a need for an updated systematic review to assess the levels of the PDR among adults newly initiating ART in Eastern Africa. METHODS We conducted a systematic search for studies published between 1 January 2017 and 30 April 2022 in the MEDLINE Complete and CINAHL Complete, searched simultaneously using EBSCOhost, and Web of Science. To determine the overall PDR prevalence estimates, we extracted data from eligible articles and analysed prevalence estimates using Stata 14.2. RESULTS A total of 22 eligible observation studies were selected. The studies included a total of 5852 ART-naive people living with HIV. The overall pooled prevalence of PDR was 10.0% (95% CI: 7.9%-12.0%, I2 = 88.9%) and 9.4% (95% CI: 7.0%-11.9%, I2 = 90.4%) for NNRTIs, 2.6% (95% CI: 1.8%-3.4%, I2 = 69.2%) for NRTIs and 0.7% (95% CI: 0.3%-1.2%, I2 = 29.0%) for PIs. No major integrase strand transfer inhibitors (INSTI)-related mutations were identified. CONCLUSIONS We observed a moderate overall PDR prevalence among new ART initiators in this study. PDR to NNRTIs is more prevalent, underscoring the importance of the current WHO recommendation for replacement of NNRTIs by INSTIs. PDR to NRTIs was low but notable, which warrants continuous surveillance of pre-existing resistance to the dolutegravir co-administered NRTI in Eastern Africa.
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Affiliation(s)
- Alex J Ntamatungiro
- Ifakara Health Institute, Ifakara, Tanzania.,Division of Epidemiology and Biostatistics, University of the Witwatersrand, Johannesburg, South Africa
| | - Juliana Kagura
- Division of Epidemiology and Biostatistics, University of the Witwatersrand, Johannesburg, South Africa
| | - Maja Weisser
- Ifakara Health Institute, Ifakara, Tanzania.,Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Joel M Francis
- Department of Family Medicine and Primary Care, University of the Witwatersrand, Johannesburg, South Africa
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Anito AA, Lenjebo TL, Woticha E, Solomon F. Magnitude of Viral Load Suppression and Associated Factors among Clients on Antiretroviral Therapy in Public Hospitals of Hawassa City Administration, Ethiopia. HIV AIDS (Auckl) 2022; 14:529-538. [PMID: 36425750 PMCID: PMC9680672 DOI: 10.2147/hiv.s387787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 11/11/2022] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND A majority of clients on first-line antiretroviral therapy with an initial high viral load will resuppress following an adherence intervention. Some sociodemographic and clinical characteristics were found to affect resuppression. Few reports on the outcome of the intervention and its associated factors in our country, with inconsistent results and some missed clinical factors of potential association, have compelled this study. The study aimed to assess the proportion of viral load suppression and associated factors among clients on antiretroviral therapy in public hospitals of Hawassa City Administration, Ethiopia. METHODS An institution-based cross-sectional study with retrospective document review was conducted among 342 participants on antiretroviral therapy enrolled for counseling since its start in November 2016. Data were captured using a pretested and structured checklist from all client charts with complete data, entered into EpiData 3.1.0 and exported to SPSS 27 for analysis. The proportion of viral load suppression was determined. Bivariate and multivariate logistic regressions were performed to identify associated factors. Statistical significance was determined at a 95% CI and P<0.05. RESULTS The proportion of viral load suppression was found to be 40.9% (35.7%-46.5%). Nevirapine-based antiretroviral treatment regimens (AOR 0.125, 95% CI 0.034-0.464), malnutrition (AOR 0.565, 95% CI 0.329-0.971), poor adherence (AOR 0.504, 95% CI 0.287-0.886), lower CD4 count (AOR 0.149, 95% CI 0.071, 0.314), and fewer counseling sessions (AOR 0.330, 95% CI 0.149-0.729) were significantly associated with viral load suppression. CONCLUSION The proportion of viral load suppression is lower than that recommended by the World Health Organization. Nevirapine-based regimens, poor nutritional status, poor adherence, lower CD4 count, and fewer counseling sessions risk a lower proportion of viral load suppression. This calls for the need to devise strategies to address these factors and to revisit program implementation.
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Affiliation(s)
| | | | - Eskinder Woticha
- School of Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Fithamlak Solomon
- School of Medical Laboratory, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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MILNE RS, BECK IA, LEVINE M, SO I, ANDERSEN N, DENG W, PANPRADIST N, KINGOO J, KIPTINNESS C, YATICH N, KIARIE JN, SAKR SR, CHUNG MH, FRENKEL LM. Low-frequency pre-treatment HIV drug resistance: effects on 2-year outcome of first-line efavirenz-based antiretroviral therapy. AIDS 2022; 36:1949-1958. [PMID: 36305180 PMCID: PMC9623471 DOI: 10.1097/qad.0000000000003361] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Assess the impact of pre-treatment high-frequency and low-frequency drug-resistant HIV variants on long-term outcomes of first-line efavirenz-based antiretroviral therapy (ART). DESIGN Prospective observational study. METHODS Participants' pre-treatment plasma RNA had two sections of HIV pol encoding reverse transcriptase sequenced (Illumina, MiSeq) using unique molecular identifiers to detect wild-type (pre-treatment drug-resistant variants less than 1% of viral quasispecies), low-frequency (1-9%) or high-frequency drug-resistant variants (10-100%). Associations between pre-treatment drug resistance and virologic outcomes over 24 months of efavirenz-based ART were assessed for the number and frequency of mutations by drug class and other resistance parameters. RESULTS Virologic failure was detected in 30 of 352 (9%) and pre-treatment drug-resistant variants were detected in the viral quasispecies of 31 of 352 (9%) participants prescribed efavirenz-based ART. Survival analyses revealed statistically significant associations between pre-treatment drug resistance at low (P < 0.0001) and high (P < 0.001) frequencies, at oligonucleotide ligation assay (OLA) (P < 0.00001) and non-OLA (P < 0.01) codons, to a single-antiretroviral class (P < 0.00001), and a shorter time to virologic failure of efavirenz-based ART. Regression analyses detected independent effects across resistance categories, including both low-frequency (P < 0.01) and high-frequency (P < 0.001) drug-resistant variants. CONCLUSION We observed that pre-treatment HIV drug resistance detected at low frequencies increased the risk of virologic failure over 24 months of efavirenz-based ART, but that most failures, regardless of drug-resistant variants' frequencies, were detected within a year of ART initiation. These observations suggest that when efavirenz-based ART is prescribed, screening for pre-treatment drug resistance by an assay capable of detecting low-frequency variants, including OLA, may guide clinicians to prescribe more effective ART.
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Affiliation(s)
- Ross S. MILNE
- Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Ingrid A. BECK
- Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Molly LEVINE
- Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Isaac SO
- Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Nina ANDERSEN
- Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Wenjie DENG
- University of Washington, Seattle, Washington, USA
| | | | - James KINGOO
- University of Washington, Seattle, Washington, USA
- Coptic Hospital, Nairobi, Kenya
| | | | - Nelly YATICH
- University of Washington, Seattle, Washington, USA
| | | | | | | | - Lisa M. FRENKEL
- Seattle Children’s Research Institute, Seattle, Washington, USA
- University of Washington, Seattle, Washington, USA
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Mengistu ST, Ghebremeskel GG, Ghebrat HB, Achila OO, Yohannes NA, Ghebrenegus AS, Wendmhuney FG, Yeibyo N, Andegiorgish AK, Mesfin AB, Leake N. Determinants of therapy failure among adults on first-line antiretroviral therapy in Asmara, Eritrea: a multicenter retrospective matched case-control study. BMC Infect Dis 2022; 22:834. [PMID: 36357837 PMCID: PMC9650854 DOI: 10.1186/s12879-022-07797-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 10/20/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Information on treatment failure (TF) in People living with HIV in a data-poor setting is necessary to counter the epidemic of TF with first-line combined antiretroviral therapies (cART) in sub-Saharan Africa (SSA). In this study, we examined the risk factors associated with TF in Asmara, Eritrea from 2001 to 2020. METHODS A multicenter, retrospective 1:2 matched (by age and gender) case-control study was conducted in four major hospitals in Asmara, Eritrea on adults aged ≥ 18 years who were on treatment for at least 6 months. Cases were patients who fulfills at least one of the WHO therapy failure criterion during the study period. Controls were randomly selected patients on first-line treatment and plasma viral load < 1000 copies/ml in their latest follow-up measurement. Multivariable logistic regression analysis was conducted to identify risk factors for TF. All P-values were 2-sided and the level of significance was set at P < 0.05 for all analyses. RESULTS Of the 1068 participants (356 cases; 712 controls), 585 (54.7%) were females. The median age at treatment initiation was 46 years [interquartile range (IQR): 39-51]. Median time to combined antiretroviral therapy (cART) failure was 37 months (IQR = 24-47). In the multivariate analysis, factors associated with increased likelihood of TF included initial nucleoside reverse transcriptase inhibitors (NRTI) backbone (Zidovudine + Lamivudine (AZT + 3TC): adjusted odds ratio (aOR) = 2.70, 95% Confidence interval (CI): 1.65-4.41, P-value < 0.001), (Abacavir + lamivudine (ABC + 3TC): aOR = 4.73, 95%CI: 1.18-18.92, P-value = 0.028], and (Stavudine + Lamivudine (D4T + 3TC): aOR = 5.00; 95% CI: 3.03-8.20, P-value < 0.001) in comparison to Emtricitabine and Tenofovir diproxil fumarate (FTC + TDF). Additional associations included prior exposure to cART (aOR = 2.28, 95%CI: 1.35-3.86; P- value = 0.002), record of sub-optimal drug adherence (aOR = 3.08, 95%CI: 2.22-4.28; P < 0.001), ambulatory/bedridden at presentation (aOR = 1.61, 95%CI: 1.12-4.28; P-value = 0.010), presence of comorbidities (aOR = 2.37; 95%CI: 1.36-4.10, P-value = 0.002), duration of cART (< 5 years: aOR: 5.90; 95% CI: 3.95-8.73, P-value < 0.001), and use of SMX-TMP prophylaxis (aOR = 2.00, 95%CI, 1.44-2.78, P-value < 0.001). CONCLUSION Our findings underscore the importance of optimizing cART adherence, diversification of cART regimens, and interventions directed at enhancing early HIV diagnosis, prompt initiations of treatment, and improved patient-focused monitoring of treatment response.
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Affiliation(s)
| | | | | | - Oliver Okoth Achila
- Unit of Clinical Laboratory Science, Orotta College of Medicine and Health Sciences, Asmara, Eritrea
| | | | | | | | - Naod Yeibyo
- Ghindae Zonal Referral Hospital, Ministry of Health Northern Red Sea Branch, Ghindae, Eritrea
| | - Amanuel Kidane Andegiorgish
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, People’s Republic of China
| | | | - Negassi Leake
- Department of Internal Medicine, Orotta College of Medicine and Health Sciences, Asmara, Eritrea
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Masaba RO, Woelk G, Herrera N, Siamba S, Simiyu R, Ochanda B, Okomo G, Odionyi J, Audo M, Mwangi E. Standardized enhanced adherence counseling for improved HIV viral suppression among children and adolescents in Homa Bay and Turkana Counties, Kenya. Medicine (Baltimore) 2022; 101:e30624. [PMID: 36221325 PMCID: PMC9542655 DOI: 10.1097/md.0000000000030624] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Viral suppression is suboptimal among children and adolescents on antiretroviral therapy (ART) in Kenya. We implemented and evaluated a standardized enhanced adherence counseling (SEAC) package to improve viral suppression in children and adolescents with suspected treatment failure in Homa Bay and Turkana. The SEAC package, implemented from February 2019 to September 2020, included: standard procedures operationalizing the enhanced adherence counseling (EAC) process; provider training on psychosocial support and communication skills for children living with HIV and their caregivers; mentorship to providers and peer educators on EAC processes; and individualized case management. We enrolled children and adolescents aged 0 to 19 years with suspected treatment failure (viral load [VL] >1000 copies/mL) who received EAC before standardization as well as those who received SEAC in a pre-post evaluation of the SEAC package conducted in 6 high-volume facilities. Pre-post standardization comparisons were performed using Wilcoxon-Mann-Whitney and Pearson's chi-square tests at a 5% level of significance. Multivariate logistic regression was performed to identify factors associated with viral resuppression. The study enrolled 741 participants, 595 pre- and 146 post-SEAC implementation. All post-SEAC participants attended at least 1 EAC session, while 17% (n = 98) of pre-SEAC clients had no record of EAC attendance. Time to EAC following the detection of high VL was reduced by a median of 8 days, from 49 (interquartile range [IQR]: 23.0-102.5) to 41 (IQR: 20.0-67.0) days pre- versus post-SEAC (P = .006). Time to completion of at least 3 sessions was reduced by a median of 12 days, from 59.0 (IQR: 36.0-91.0) to 47.5 (IQR: 33.0-63.0) days pre- versus post-SEAC (P = .002). A greater percentage of clients completed the recommended minimum 3 EAC sessions at post-SEAC, 88.4% (n = 129) versus 61.1% (n = 363) pre-SEAC, P < .001. Among participants with a repeat VL within 3 months following the high VL, SEAC increased viral suppression from 34.6% (n = 76) to 52.5% (n = 45), P = .004. Implementation of the SEAC package significantly reduced the time to initiate EAC and time to completion of at least 3 EAC sessions, and was significantly associated with viral suppression in children and adolescents with suspected treatment failure.
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Affiliation(s)
- Rose Otieno Masaba
- Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, Kenya
- *Correspondence: Rose Otieno Masaba, Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, Kenya (e-mail: )
| | - Godfrey Woelk
- Elizabeth Glaser Pediatric AIDS Foundation, WA, DC, USA
| | | | - Stephen Siamba
- Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, Kenya
| | - Rogers Simiyu
- Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, Kenya
| | - Boniface Ochanda
- US Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV & TB, Kisumu, Kenya
| | | | | | - Michael Audo
- Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, Kenya
| | - Eliud Mwangi
- Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, Kenya
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Beesham I, Parikh UM, Mellors JW, Joseph Davey DL, Heffron R, Palanee-Phillips T, Bosman SL, Beksinska M, Smit J, Ahmed K, Makkan H, Selepe P, Louw C, Kotze P, Hofmeyr GJ, Singata‐Madliki M, Rees H, Baeten JM, Wallis C. High Levels of Pretreatment HIV-1 Drug Resistance Mutations Among South African Women Who Acquired HIV During a Prospective Study. J Acquir Immune Defic Syndr 2022; 91:130-137. [PMID: 36094478 PMCID: PMC9651927 DOI: 10.1097/qai.0000000000003027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 04/07/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pretreatment HIV drug resistance (PDR) undermines individual treatment success and threatens the achievement of UNAIDS 95-95-95 targets. In many African countries, limited data are available on PDR as detection of recent HIV infection is uncommon and access to resistance testing is limited. We describe the prevalence of PDR among South African women with recent HIV infection from the Evidence for Contraceptive Options and HIV Outcomes (ECHO) Trial. METHODS HIV-uninfected, sexually active women, aged 18-35 years, and seeking contraception were enrolled in the ECHO Trial at sites in South Africa, from 2015 to 2018. HIV testing was done at trial entry and repeated quarterly. We tested stored plasma samples collected at HIV diagnosis from women who seroconverted during follow-up and had a viral load >1000 copies/mL for antiretroviral resistant mutations using a validated laboratory-developed population genotyping assay, which sequences the full protease and reverse transcriptase regions. Mutation profiles were determined using the Stanford Drug Resistance Database. RESULTS We sequenced 275 samples. The median age was 23 years, and majority (98.9%, n = 272) were infected with HIV-1 subtype C. The prevalence of surveillance drug resistance mutations (SDRMs) was 13.5% (n = 37). Nonnucleoside reverse transcriptase inhibitor (NNRTI) mutations were found in 12.4% of women (n = 34). Few women had NRTI (1.8%, n = 5) and protease inhibitor (1.1%, n = 3) mutations. Five women had multiple NRTI and NNRTI SDRMs. CONCLUSIONS The high levels of PDR, particularly to NNRTIs, strongly support the recent change to the South African national HIV treatment guidelines to transition to a first-line drug regimen that excludes NNRTIs.
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Affiliation(s)
- Ivana Beesham
- MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Urvi M. Parikh
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - John W. Mellors
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Dvora L. Joseph Davey
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA
| | - Renee Heffron
- Department of Global Health and Department of Epidemiology, University of Washington, Seattle, WA
| | - Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shannon L. Bosman
- MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Mags Beksinska
- MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Jennifer Smit
- MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Khatija Ahmed
- Setshaba Research Centre, Soshanguve, South Africa
- Faculty of Health Sciences, Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
| | - Heeran Makkan
- The Aurum Institute, Klerksdorp, South Africa
- Department of Interdisciplinary Social Science, Public Health, Utrecht University, Utrecht, The Netherlands
| | | | - Cheryl Louw
- Madibeng Centre for Research, Brits, South Africa
- Department of Family Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Philip Kotze
- Qhakaza Mbokodo Research Clinic, Ladysmith, South Africa
| | - G. Justus Hofmeyr
- Effective Care Research Unit, Universities of the Witwatersrand, Walter Sisulu and Fort Hare and Eastern Cape Department of Health, East London, South Africa
- Department of Obstetrics and Gynaecology, University of Botswana, Gaborone, Botswana
| | - Mandisa Singata‐Madliki
- Effective Care Research Unit, Universities of the Witwatersrand, Walter Sisulu and Fort Hare and Eastern Cape Department of Health, East London, South Africa
- Effective Care Research Unit, Universities of the Witwatersrand and Fort Hare and Eastern Cape Department of Health, East London, South Africa
| | - Helen Rees
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jared M. Baeten
- Department of Global Health, Department of Epidemiology, Department of Medicine, University of Washington, Seattle, WA
- Currently, Gilead Sciences, Foster City, CA; and
| | - Carole Wallis
- BARC-SA and Lancet Laboratories, Johannesburg, South Africa
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Li D, Chen H, Li H, Ma Y, Dong L, Dai J, Jin X, Yang M, Zeng Z, Sun P, Song Z, Chen M. HIV-1 pretreatment drug resistance and genetic transmission network in the southwest border region of China. BMC Infect Dis 2022; 22:741. [PMID: 36117159 PMCID: PMC9483295 DOI: 10.1186/s12879-022-07734-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV drug resistance increased with the widespread use of antiretroviral drugs, and posed great threat to antiretroviral therapy (ART). Pu'er Prefecture, lying in the southwest of Yunnan Province, China, borders Myanmar, Laos and Vietnam, is also the area where AIDS was discovered earlier, however, in which there has been no information on HIV drug resistance. METHODS A cross-sectional survey of pretreatment drug resistance (PDR) was conducted in Pu'er Prefecture in 2021. Partial pol gene sequences were obtained to analyze drug resistance and construct genetic transmission network. HIV drug resistance was analyzed using the Stanford University HIVdb algorithm. RESULTS A total of 295 sequences were obtained, among which 11 HIV-1 strain types were detected and CRF08_BC (62.0%, 183/295) was the predominant one. Drug resistance mutations (DRMs) were detected in 42.4% (125/295) of the sequences. The prevalence of PDR to any antiretroviral drugs, nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs) were 10.8% (32/295), 9.5% (28/295), 1.0% (3/295) and 0.3% (1/295), respectively. The risk of PDR occurrence was higher among individuals with CRF01_AE strain types. HIV-1 molecular network was constructed, in which 56.0% (42/75) of links were transregional, and 54.7% (41/75) of links were associated with Lancang County. Among the sequences in the network, 36.8% (35/95) harbored DRMs, and 9.5% (9/95) were drug resistance strains. Furthermore, 8 clusters had shared DRM. CONCLUSION The overall prevalence of PDR in this study was in a moderate level, but NNRTIs resistance was very approaching to the threshold of public response initiation. PDR was identified in the transmission network, and DRMs transmission was observed. These findings suggested that the consecutive PDR surveillance should be conducted in this region.
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Affiliation(s)
- Difei Li
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Huichao Chen
- Institute for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, No 158, Dongsi Street, Xishan District, Kunming, 650022, Yunnan Province, China
| | - Huilan Li
- Division for AIDS/STD Control and Prevention, Pu'er Center for Disease Control and Prevention, Pu'er, Yunnan, China
| | - Yanling Ma
- Institute for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, No 158, Dongsi Street, Xishan District, Kunming, 650022, Yunnan Province, China
| | - Lijuan Dong
- Institute for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, No 158, Dongsi Street, Xishan District, Kunming, 650022, Yunnan Province, China
| | - Jie Dai
- Institute for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, No 158, Dongsi Street, Xishan District, Kunming, 650022, Yunnan Province, China
| | - Xiaomei Jin
- Institute for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, No 158, Dongsi Street, Xishan District, Kunming, 650022, Yunnan Province, China
| | - Min Yang
- Institute for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, No 158, Dongsi Street, Xishan District, Kunming, 650022, Yunnan Province, China
| | - Zhijun Zeng
- Institute for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, No 158, Dongsi Street, Xishan District, Kunming, 650022, Yunnan Province, China
| | - Pengyan Sun
- Institute for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, No 158, Dongsi Street, Xishan District, Kunming, 650022, Yunnan Province, China
| | - Zhizhong Song
- Institute for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, No 158, Dongsi Street, Xishan District, Kunming, 650022, Yunnan Province, China.
| | - Min Chen
- Institute for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, No 158, Dongsi Street, Xishan District, Kunming, 650022, Yunnan Province, China.
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Ismael N, Wilkinson E, Mahumane I, Gemusse H, Giandhari J, Bauhofer A, Vubil A, Mambo P, Singh L, Mabunda N, Bila D, Engelbrecht S, Gudo E, Lessells R, de Oliveira T. Molecular Epidemiology and Trends in HIV-1 Transmitted Drug Resistance in Mozambique 1999–2018. Viruses 2022; 14:v14091992. [PMID: 36146798 PMCID: PMC9505726 DOI: 10.3390/v14091992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 11/20/2022] Open
Abstract
HIV drug resistance (HIVDR) can become a public health concern, especially in low- and middle-income countries where genotypic testing for people initiating antiretroviral therapy (ART) is not available. For first-line regimens to remain effective, levels of transmitted drug resistance (TDR) need to be monitored over time. To determine the temporal trends of TDR in Mozambique, a search for studies in PubMed and sequences in GenBank was performed. Only studies covering the pol region that described HIVDR and genetic diversity from treatment naïve patients were included. A dataset from seven published studies and one novel unpublished study conducted between 1999 and 2018 were included. The Calibrated Population Resistance tool (CPR) and REGA HIV-1 Subtyping Tool version 3 for sequences pooled by sampling year were used to determine resistance mutations and subtypes, respectively. The prevalence of HIVDR amongst treatment-naïve individuals increased over time, reaching 14.4% in 2018. The increase was most prominent for non-nucleoside reverse transcriptase inhibitors (NNRTIs), reaching 12.7% in 2018. Subtype C was predominant in all regions, but a higher genetic variability (19% non-subtype C) was observed in the north region of Mozambique. These findings confirm a higher diversity of HIV in the north of the country and an increased prevalence of NNRTI resistance among treatment naïve individuals over time.
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Affiliation(s)
- Nalia Ismael
- Instituto Nacional de Saúde (INS), Estrada Nacional N1, Marracuene 3943, Mozambique
- Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 8000, South Africa
- Correspondence: (N.I.); (T.d.O.)
| | - Eduan Wilkinson
- Centre for Epidemic Response and Innovation (CERI), School of Data Science and Computational Thinking, Stellenbosch University, Stellenbosch 7602, South Africa
| | - Isabel Mahumane
- Instituto Nacional de Saúde (INS), Estrada Nacional N1, Marracuene 3943, Mozambique
| | - Hernane Gemusse
- Instituto Nacional de Saúde (INS), Estrada Nacional N1, Marracuene 3943, Mozambique
| | - Jennifer Giandhari
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban 4000, South Africa
| | - Adilson Bauhofer
- Instituto Nacional de Saúde (INS), Estrada Nacional N1, Marracuene 3943, Mozambique
| | - Adolfo Vubil
- Instituto Nacional de Saúde (INS), Estrada Nacional N1, Marracuene 3943, Mozambique
| | - Pirolita Mambo
- Instituto Nacional de Saúde (INS), Estrada Nacional N1, Marracuene 3943, Mozambique
| | - Lavanya Singh
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban 4000, South Africa
| | - Nédio Mabunda
- Instituto Nacional de Saúde (INS), Estrada Nacional N1, Marracuene 3943, Mozambique
| | - Dulce Bila
- Elizabeth Glaser Pediatric AIDS Foundation in Mozambique, Avenida Agostinho Neto, Maputo 620, Mozambique
| | - Susan Engelbrecht
- Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 8000, South Africa
| | - Eduardo Gudo
- Instituto Nacional de Saúde (INS), Estrada Nacional N1, Marracuene 3943, Mozambique
| | - Richard Lessells
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban 4000, South Africa
| | - Túlio de Oliveira
- Centre for Epidemic Response and Innovation (CERI), School of Data Science and Computational Thinking, Stellenbosch University, Stellenbosch 7602, South Africa
- Correspondence: (N.I.); (T.d.O.)
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Parbie PK, Abana CZY, Kushitor D, Asigbee TW, Ntim NAA, Addo-Tetebo G, Ansong MRD, Ofori SB, Mizutani T, Runtuwene LR, Nishizawa M, Ishikawa K, Kiyono H, Ampofo WK, Matano T, Bonney EY, Kikuchi T. High-level resistance to non-nucleos(t)ide reverse transcriptase inhibitor based first-line antiretroviral therapy in Ghana; A 2017 study. Front Microbiol 2022; 13:973771. [PMID: 36090108 PMCID: PMC9459847 DOI: 10.3389/fmicb.2022.973771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/14/2022] [Indexed: 11/21/2022] Open
Abstract
Expanding access to effective antiretroviral therapy (ART) is a major tool for management of Human Immunodeficiency Virus (HIV) infection. However, rising levels of HIV drug-resistance have significantly hampered the anticipated success of ART in persons living with HIV (PLWH), particularly those from Africa. Though great strides have been made in Ghana toward achieving the UNAIDS “95-95-95” target, a substantial number of PLWH receiving ART have not attained viral suppression. This study investigated patterns of drug resistance mutations in ART naïve as well as ART-experienced PLWH receiving first-line regimen drugs from Ghana. In a cross-sectional study, blood samples were collected from HIV-1 infected adults (≥18 years) attending HIV/AIDS clinic at the Eastern Regional Hospital, Koforidua, Ghana from September to October 2017. Viral RNA isolated from plasma were subjected to genotypic drug resistance testing for Protease Inhibitors (PI), Reverse Transcriptase Inhibitors (RTI), and Integrase Strand Transfer Inhibitors (INSTI). A total of 95 (84 ART experienced, 11 ART naïve) HIV-1 infected participants were sampled in this study. Sixty percent (50/84) of the ART-experienced participants were controlling viremia (viral load < 1,000 copies/ml). Of the 95 patient samples, 32, 34, and 33 were successfully sequenced for protease, reverse-transcriptase, and integrase regions, respectively. The dominant HIV-1 subtypes detected were CRF02_AG (70%), and A3 (10%). Major drug resistance associated mutations were only detected for reverse transcriptase inhibitors. The predominant drug resistance mutations were against nucleos(t)ide reverse transcriptase inhibitors (NRTI)—M184V/I and non-nucleos(t)ide reverse transcriptase inhibitors (NNRTI)—K103N. In the ART-experienced group, M184V/I and K103N were detected in 54% (15/28) and 46% (13/28) of individuals, respectively. Both mutations were each detected in 33% (2/6) of ART naïve individuals. Multiclass resistance to NRTI and NNRTI was detected in 57% of ART-experienced individuals and two ART naïve individuals. This study reports high-level resistance to NNRTI-based antiretroviral therapy in PLWH in Ghana. However, the absence of major PI and INSTI associated-mutations is a good signal that the current WHO recommendation of Dolutegravir in combination with an NRTI backbone will yield maximum benefits as first-line regimen for PLWH in Ghana.
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Affiliation(s)
- Prince Kofi Parbie
- AIDS Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Christopher Zaab-Yen Abana
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
- West African Center for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Accra, Ghana
- Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana
| | - Dennis Kushitor
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Theodore Worlanyo Asigbee
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
- Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
| | - Nana Afia Asante Ntim
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
- Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
| | - Gifty Addo-Tetebo
- Eastern Regional Hospital Koforidua, Ghana Health Service, Koforidua, Ghana
| | | | - Sampson Badu Ofori
- Eastern Regional Hospital Koforidua, Ghana Health Service, Koforidua, Ghana
| | | | | | - Masako Nishizawa
- AIDS Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Koichi Ishikawa
- AIDS Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Hiroshi Kiyono
- The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
- Future Medicine Education and Research Organization, Institute for Global Prominent Research, Graduate School of Medicine, Chiba University, Chiba, Japan
- Department of Medicine, Chiba University-University of California San Diego Center for Mucosal Immunology, Allergy and Vaccines (cMAV) University of California San Diego, San Diego, CA, United States
| | | | - Tetsuro Matano
- AIDS Research Center, National Institute of Infectious Diseases, Tokyo, Japan
- Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
- The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Evelyn Yayra Bonney
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
- *Correspondence: Evelyn Yayra Bonney,
| | - Tadashi Kikuchi
- AIDS Research Center, National Institute of Infectious Diseases, Tokyo, Japan
- Tadashi Kikuchi,
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Beichler H, Grabovac I, Leichsenring B, Dorner TE. Involvement, Perception, and Understanding as Determinants for Patient-Physician Relationship and Their Association with Adherence: A Questionnaire Survey among People Living with HIV and Antiretroviral Therapy in Austria. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10314. [PMID: 36011949 PMCID: PMC9408219 DOI: 10.3390/ijerph191610314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/09/2022] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The relationship between patients and healthcare professionals (physicians) is the cornerstone of successful long-term antiretroviral therapy for people living with human immunodeficiency virus (HIV). PURPOSE This study aimed to investigate the connection between involvement, perception, and understanding as the basis for the patient-physician relationship and drug adherence, measured as the probability of non-adherence. METHODS In an online survey, people with HIV were asked about their relationship with their physicians and the extent to which they felt involved in treatment-related decisions. A statistical analysis was conducted to determine whether a better patient-physician relationship was associated with higher adherence to therapy. This was performed by univariate group comparison (Mann-Whitney-U, Fishers Exact Test) and logistic regression. RESULTS A total of 303 persons living with HIV participated in the survey, and 257 patients were included in the analysis. Overall, 27.6% were classified as non-adherent and self-reporting based on whether an antiretroviral therapy (ART) was taken in the past or how often the ART was interrupted. This proportion was significantly higher among patients aged 50-74 years (39.7%) and those with a longer therapy duration (9-15 years: 46.6%; from 15 years on: 55.8%). Therapy-non-adherent patients showed significantly lower scores in the relationship aspects understanding (2.68 vs. 3.03), participation (2.63 vs. 3.07), and perception (3.00 vs. 3.24) compared to adherent patients. Logistic regression analysis confirms that higher scores for understanding, involvement, and perception are strongly associated with a reduction in the risk of becoming non-adherent. This was true for all examined regression models, regardless of whether they were adjusted for the length of therapy and socio-demographic characteristics. CONCLUSION The results reinforce the need for awareness among health care professionals (HCP) regarding understanding, involvement, and perception as important aspects to improve the quality of the patient-physician relationship for high adherence levels with maximized non-adherence in ART management by PLWH.
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Affiliation(s)
- Helmut Beichler
- General Hospital, Nursing School, Medical University Vienna, 1090 Wien, Austria
| | - Igor Grabovac
- Centre for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, 1090 Wien, Austria
| | | | - Thomas Ernst Dorner
- Centre for Public Health, Department of Social and Preventive Medicine, Unite Lifestyle and Prevention, Medical University of Vienna, 1090 Wien, Austria
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Dravid A, Morkar D, Prasad D, Ramapuram JT, Patel KV, Naik KS, Bhrusundi M, Kulkarni M, Hegde S, Anuradha S, Nageswaramma S, Madan S, Jayaprakash T, Kulkarni V. A Phase IV Study on Safety, Tolerability and Efficacy of Dolutegravir, Lamivudine, and Tenofovir Disoproxil Fumarate in Treatment Naïve Adult Indian Patients Living with HIV-1. Pragmat Obs Res 2022; 13:75-84. [PMID: 35975180 PMCID: PMC9375976 DOI: 10.2147/por.s361907] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 07/25/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose WHO recommends dolutegravir (DTG) based regimens as first-line treatment for HIV-1 infection. However, few studies have been conducted in Indian population. Hence, our study evaluated the safety, tolerability, and efficacy of DTG 50 mg with Tenofovir and Lamivudine (300/300mg) fixed dose combination in treatment naïve adult Indian patients. Methods This was an open label, multicenter, prospective, interventional, phase IV study conducted across 14 sites between February 2019 and July 2020. 24 weeks was the treatment duration for each subject. The primary end point was to assess the incidence of adverse events (AEs) and secondary end points were to assess the proportion of patients achieving plasma HIV-1 RNA levels <50 copies/mL at week 24 and change in CD4+ cell count from the baseline. Safety analysis was conducted using Safety Analysis Set and efficacy analysis was carried out using Full Analysis Set and Per protocol set. Results A total of 288 patients were screened; 250 were enrolled; and 229 completed the study. 389 AEs were reported from 58% of patients. Of these, 61 were related to study treatment. One event of decreased creatinine clearance led to study discontinuation. One serious event of pyrexia was reported, which was unrelated to the study drug. The most common AEs were headache (18%), pyrexia (14%), vomiting (6.4%) and upper respiratory tract infections (6%). No deaths were reported. At week 24, 86.8% of the patients achieved plasma HIV-1 RNA levels <50 copies/mL and the mean CD4 cell count increased from 350.2 (SD, 239.73) at baseline to 494.6 (SD, 261.40) with an average increase of 143.2 (SD, 226.14) cells. Conclusion This study demonstrated the safety and efficacy of DTG based regimen in treatment naïve HIV-1 patients in Indian population and support use of DTG as first-line treatment regimen.
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Affiliation(s)
- Ameet Dravid
- Department of Infectious Diseases and Clinical Research, Poona Hospital and Research Centre, Pune, Maharashtra, India
| | - Dnyanesh Morkar
- Department of Medicine, KLE's Dr Prabhakar Kore Hospital and MRC, Belagavi, Karnataka, India
| | - Dwijendra Prasad
- Department of General Medicine, People Tree Hospital 2, Bangalore, Karnataka, India
| | - John T Ramapuram
- Department of Medicine, Kasturba Medical College Hospital, Mangalore, Karnataka, India
| | | | - K Sunil Naik
- Department of General Medicine, Rajiv Gandhi Institute of Medical Sciences and RIMS Government General Hospital, Srikakulam, Andhra Pradesh, India
| | - Milind Bhrusundi
- Department of Medicine, Lata Mangeshkar Multi Specialty Hospital, Nagpur, Maharashtra, India
| | - Milind Kulkarni
- Department of Medicine, Sahyadri Super Specialty Hospital, Pune, Maharashtra, India
| | - Sanjeev Hegde
- Department of Global Clinical Operations, Viatris, Bengaluru, Karnataka, India
| | - S Anuradha
- Department of Medicine, Maulana Azad Medical College and Associated Lok Nayak, New Delhi, India
| | | | - Surabhi Madan
- Department of Clinical Research, Care Institute of Medical Sciences (CIMS) Hospital, Ahmedabad, Gujarat, India
| | | | - Vinay Kulkarni
- Department of Dermatology, LMMF's Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
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Fogel JM, Wilson EA, Piwowar-Manning E, Breaud A, Clarke W, Petropoulos C, Moore A, Fraser C, Kosloff B, Shanaube K, van Zyl G, Scheepers M, Floyd S, Bock P, Ayles H, Fidler S, Hayes R, Donnell D, Eshleman SH. HIV drug resistance in a community-randomized trial of universal testing and treatment: HPTN 071 (PopART). J Int AIDS Soc 2022; 25:e25941. [PMID: 35775502 PMCID: PMC9248006 DOI: 10.1002/jia2.25941] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 05/19/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Universal HIV testing and treatment (UTT) has individual and public health benefits. HPTN 071 (PopART), a community-randomized trial in Zambia and South Africa, demonstrated that UTT decreased HIV incidence. This endpoint was assessed in a cohort of >48,000 randomly selected adults in the study communities. We evaluated the impact of UTT on HIV drug resistance in this cohort and compared other resistance-related outcomes in participants with recent versus non-recent HIV infection. METHODS Two years after the start of HPTN 071 (2016-2017), 6259 participants were HIV positive and 1902 were viremic (viral load >400 copies/ml). HIV genotyping and antiretroviral (ARV) drug testing were performed for viremic participants in three groups: seroconverters (infected <1 year), non-seroconverters (infected >1 year, random subset) and participants with unknown duration of infection (random subset). A two-stage cluster-based approach was used to assess the impact of the study intervention on drug resistance. Treatment failure was defined as being viremic with ARV drugs detected. Participants were classified as ARV naïve based on self-report and ARV drug testing. RESULTS Genotyping results were obtained for 758 participants (143 seroconverters; 534 non-seroconverters; and 81 unknown duration of infection). The estimated prevalence of resistance in the study communities was 37% for all viremic persons and 11% for all HIV-positive persons. There was no association between UTT and drug resistance. Resistance was detected in 14.0% of seroconverters and 40.8% of non-seroconverters (non-nucleoside reverse transcriptase inhibitor resistance: 14.0% and 39.9%; nucleoside/nucleotide reverse transcriptase inhibitor resistance: 0.7% and 15.5%; protease inhibitor resistance: 0% and 1.9%; multi-class resistance: 0.7% and 16.1%, respectively). ARV drugs were detected in 2/139 (1.4%) of seroconverters and 94/534 (17.6%) of non-seroconverters tested. These participants were classified as failing ART; 88 (93.6%) of the non-seroconverters failing ART had resistance. Mutations used for surveillance of transmitted drug resistance were detected in 10.5% of seroconverters and 15.1% of non-seroconverters who were ARV naive. CONCLUSIONS UTT was not associated with an increase in drug resistance in this cohort. Higher rates of drug resistance and multi-class resistance were observed in non-seroconverters compared to seroconverters.
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Affiliation(s)
- Jessica M Fogel
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ethan A Wilson
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Estelle Piwowar-Manning
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Autumn Breaud
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - William Clarke
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | | | - Christophe Fraser
- The Big Data Institute and Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Barry Kosloff
- Zambart, Lusaka, Zambia.,Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Gert van Zyl
- Division of Medical Virology, Stellenbosch University, Cape Town, South Africa
| | - Michelle Scheepers
- Desmond Tutu TB Center, Department of Paediatrics and Child Health, Stellenbosch University, Western Cape, South Africa
| | - Sian Floyd
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter Bock
- Desmond Tutu TB Center, Department of Paediatrics and Child Health, Stellenbosch University, Western Cape, South Africa
| | - Helen Ayles
- Zambart, Lusaka, Zambia.,Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Sarah Fidler
- Department of Infectious Disease, HIV Clinical Trials Unit, Imperial College London, London, UK
| | - Richard Hayes
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Deborah Donnell
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Susan H Eshleman
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Abstract
PURPOSE OF REVIEW HIV-1 drug resistance (HIV DR) testing is routinely performed by genotyping plasma viruses using Sanger population sequencing. Next-generation sequencing (NGS) is increasingly replacing standardized Sanger sequencing. This opens up new opportunities, but also brings challenges. RECENT FINDINGS The number of NGS applications and protocols for HIV DR testing is increasing. All of them are noninferior to Sanger sequencing when comparing NGS-derived consensus sequences to Sanger sequencing-derived sequences. In addition, NGS enables high-throughput sequencing of near full-length HIV-1 genomes and detection of low-abundance drug-resistant HIV-1 variants, although their clinical implications need further investigation. Several groups have defined remaining challenges in implementing NGS protocols for HIV-1 resistance testing. Some of them are already being addressed. One of the most important needs is quality management and consequently, if possible, standardization. SUMMARY The use of NGS technologies on HIV DR testing will allow unprecedented insights into genomic structures of virus populations that may be of immediate relevance to both clinical and research areas such as personalized antiretroviral treatment. Efforts continue to tackle the remaining challenges in NGS-based HIV DR testing.
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Kemp SA, Charles OJ, Derache A, Smidt W, Martin DP, Iwuji C, Adamson J, Govender K, de Oliveira T, Dabis F, Pillay D, Goldstein RA, Gupta RK. HIV-1 Evolutionary Dynamics under Nonsuppressive Antiretroviral Therapy. mBio 2022; 13:e0026922. [PMID: 35446121 PMCID: PMC9239331 DOI: 10.1128/mbio.00269-22] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/28/2022] [Indexed: 12/19/2022] Open
Abstract
Prolonged virologic failure on 2nd-line protease inhibitor (PI)-based antiretroviral therapy (ART) without emergence of major protease mutations is well recognized and provides an opportunity to study within-host evolution in long-term viremic individuals. Using next-generation sequencing and in silico haplotype reconstruction, we analyzed whole-genome sequences from longitudinal plasma samples of eight chronically infected HIV-1-positive individuals failing 2nd-line regimens from the French National Agency for AIDS and Viral Hepatitis Research (ANRS) 12249 Treatment as Prevention (TasP) trial. On nonsuppressive ART, there were large fluctuations in synonymous and nonsynonymous variant frequencies despite stable viremia. Reconstructed haplotypes provided evidence for selective sweeps during periods of partial adherence, and viral haplotype competition, during periods of low drug exposure. Drug resistance mutations in reverse transcriptase (RT) were used as markers of viral haplotypes in the reservoir, and their distribution over time indicated recombination. We independently observed linkage disequilibrium decay, indicative of recombination. These data highlight dramatic changes in virus population structure that occur during stable viremia under nonsuppressive ART. IMPORTANCE HIV-1 infections are most commonly initiated with a single founder virus and are characterized by extensive inter- and intraparticipant genetic diversity. However, existing literature on HIV-1 intrahost population dynamics is largely limited to untreated infections, predominantly in subtype B-infected individuals. The manuscript characterizes viral population dynamics in long-term viremic treatment-experienced individuals, which has not been previously characterized. These data are particularly relevant for understanding HIV dynamics but can also be applied to other RNA viruses. With this unique data set we propose that the virus is highly unstable, and we have found compelling evidence of HIV-1 within-host viral diversification, recombination, and haplotype competition during nonsuppressive ART.
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Affiliation(s)
- Steven A. Kemp
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), University of Cambridge, Cambridge, United Kingdom
| | - Oscar J. Charles
- Division of Infection & Immunity, University College London, London, United Kingdom
| | - Anne Derache
- Africa Health Research Institute, Durban, South Africa
| | - Werner Smidt
- Africa Health Research Institute, Durban, South Africa
| | - Darren P. Martin
- Department of Integrative Biomedical Sciences, University of Cape Town, Cape Town, South Africa
| | - Collins Iwuji
- Africa Health Research Institute, Durban, South Africa
- Research Department of Infection and Population Health, University College London, United Kingdom
| | - John Adamson
- Africa Health Research Institute, Durban, South Africa
| | | | - Tulio de Oliveira
- Africa Health Research Institute, Durban, South Africa
- KRISP - KwaZulu-Natal Research and Innovation Sequencing Platform, UKZN, Durban, South Africa
| | - Francois Dabis
- INSERM U1219-Centre Inserm Bordeaux Population Health, Université de Bordeaux, France
- Université de Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, France
| | - Deenan Pillay
- Division of Infection & Immunity, University College London, London, United Kingdom
| | - Richard A. Goldstein
- Division of Infection & Immunity, University College London, London, United Kingdom
| | - Ravindra K. Gupta
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), University of Cambridge, Cambridge, United Kingdom
- Africa Health Research Institute, Durban, South Africa
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Li M, Song C, Dong A, Hu J, Kang R, Xing H, Ruan Y, Shao Y, Hong K, Liao L. Impact of HIV Pretreatment Drug Resistance on Virological Failure After One-Year Antiretroviral Therapy - China, 2018-2019. China CDC Wkly 2022; 4:535-540. [PMID: 35813886 PMCID: PMC9260085 DOI: 10.46234/ccdcw2022.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 06/13/2022] [Indexed: 12/04/2022] Open
Abstract
WHAT IS ALREADY KNOWN ABOUT THIS TOPIC? While antiretroviral therapy (ART) has been rapidly scaled-up among the population living with human immunodeficiency virus or acquired immune deficiency syndrome (HIV/AIDS) patients since 2016, pretreatment drug resistance (PDR) has also increased. WHAT IS ADDED BY THIS REPORT? PDR has an impact on ART outcomes. After one year of ART, the risk of virological failure in individuals with PDR was found to be 2.3 times higher than that of individuals without PDR. Moreover, patients with PDR to non-nucleoside reverse transcriptase inhibitors (NNRTIs) had an even higher risk of virological failure, with an odds ratio of 2.8 as compared with those without PDR. WHAT ARE THE IMPLICATIONS FOR PUBLIC HEALTH PRACTICE? PDR is associated with an increased risk of virological failure. It is recommended to regularly implement PDR monitoring in order to provide information to optimize ART regimens and to prevent HIV drug resistance.
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Affiliation(s)
- Miaomiao Li
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chang Song
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Aobo Dong
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jing Hu
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ruihua Kang
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hui Xing
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yuhua Ruan
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yiming Shao
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Kunxue Hong
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lingjie Liao
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China,Lingjie Liao,
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Aguilar G, Truong HHM, Ovelar P, Samudio T, Lopez G, García-Morales C, Tapia-Trejo D, López-Sánchez DM, Ávila-Ríos S, Giron A, De Arias AR, Rios-Gonzalez C, McFarland W. HIV drug resistance in persons initiating or reinitiating first-line antiretroviral therapy in Paraguay: Results of a National Patient Survey. J Med Virol 2022; 94:5061-5065. [PMID: 35701340 DOI: 10.1002/jmv.27933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/06/2022] [Accepted: 06/09/2022] [Indexed: 11/06/2022]
Abstract
Human immunodeficiency virus (HIV) drug resistance increases mortality and morbidity and antiretroviral therapy (ART) costs. We describe Paraguay's first nationally representative survey on pretreatment drug resistance (PDR) conducted among persons who initiated or reinitiated ART in 2019. We conducted a cross-sectional survey of antiretroviral (ARV) drug resistance in Paraguay in 2019. Participants were sampled at four comprehensive care clinics where 90% of patients with HIV in Paraguay initiate ART. Patients included were adults ≥18 years old who initiated first-line ART or reinitiated the same first-line ART regimen after ≥3 months of discontinuation. Of 208 patients, 93.8% had no prior ART exposure, 3.8% reinitiated the same regimen, 2.4% had unknown prior ART exposure; and 31.3% had a CD4 count <200 cells/µl. Mutations associated with resistance were present in 15.4% of patients. Mutations associated with resistance to nonnucleoside reverse transcriptase inhibitors (NNRTI) were present in 13.0% of patients, nucleoside reverse transcriptase inhibitors in 4.3%, and integrase inhibitors in 3.4%. Mutations associated with resistance to tenofovir were present in 1.0% of patients and emtricitabine/lamivudine in 1.4%. Nearly one in six patients had PDR in Paraguay's first nationally representative sample. High NNRTI PDR prevalence underscores the need to accelerate the transition to dolutegravir-based first-line ART. The low PDR prevalence of tenofovir and emtricitabine is reassuring as these ARVs are part of the World Health Organization (WHO)-recommended oral pre-exposure prophylaxis regimen. The high proportion of individuals initiating ART at a late disease stage highlights the need to improve treatment linkage strategies and implement WHO rapid ART initiation recommendations.
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Affiliation(s)
- Gloria Aguilar
- National Control Program for HIV/AIDS/STI, República del Paraguay Ministry of Public Health and Social Welfare, Asunción, Paraguay
| | - Hong-Ha M Truong
- Department of Medicine, Center for Public Health Research, University of California, San Francisco, California, USA
| | - Patricia Ovelar
- National Control Program for HIV/AIDS/STI, República del Paraguay Ministry of Public Health and Social Welfare, Asunción, Paraguay
| | - Tania Samudio
- National Control Program for HIV/AIDS/STI, República del Paraguay Ministry of Public Health and Social Welfare, Asunción, Paraguay
| | - Gladys Lopez
- National Control Program for HIV/AIDS/STI, República del Paraguay Ministry of Public Health and Social Welfare, Asunción, Paraguay
| | - Claudia García-Morales
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Daniela Tapia-Trejo
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Dulce M López-Sánchez
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Santiago Ávila-Ríos
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Amalia Giron
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | | | - Carlos Rios-Gonzalez
- Direccion de Investigacion, Facultad de Ciencias Medicas, Universidad Nacional de Caaguazú, Coronel Oviedo, Paraguay
| | - Willi McFarland
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, California, USA
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Jin X, Shi L, Wang C, Qiu T, Yin Y, Shen M, Fu G, Peng Z. Cost-effectiveness of oral pre-exposure prophylaxis and expanded antiretroviral therapy for preventing HIV infections in the presence of drug resistance among men who have sex with men in China: A mathematical modelling study. THE LANCET REGIONAL HEALTH - WESTERN PACIFIC 2022; 23:100462. [PMID: 35542892 PMCID: PMC9079770 DOI: 10.1016/j.lanwpc.2022.100462] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Oral pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) can effectively prevent HIV infections among men who have sex with men (MSM), but the emergence and transmission of HIV drug-resistance (HIVDR) may compromise their benefits. The costs and benefits of expanding PrEP and ART coverage in the presence of HIVDR in China remain unknown. Methods We developed a comprehensive dynamic transmission model incorporating the transmitted (TDR) and acquired (ADR) HIV drug resistance. The model was calibrated by the HIV surveillance data from 2009 to 2019 among MSM in Jiangsu Province, China, and validated by the dynamic prevalence of ADR and TDR. We aimed to investigate the impact of eight intervention scenarios (no PrEP, 20%, 50% or 80% of PrEP, without (77% coverage) or with (90% coverage) expanded ART) on the HIV epidemic trend and cost-effectiveness of PrEP over the next 30 years. Findings 20% or 50% PrEP + 90% ART would be cost-effective, with an incremental cost-effectiveness ratio (ICER) of 25,417 (95% confidence interval [CI]: 12,390–38,445) or 47,243 (23,756–70,729), and would yield 154,949 (89,662–220,237) or 179,456 (102,570–256,342) incremental quality-adjusted life-years (QALYs) over the next 30 years. No PrEP + 90% ART would yield 125,211 (73,448–176,974) incremental QALYs and be cost-saving. However, 20–80% PrEP + 77% ART and 80% PrEP + 90% ART with ICER of $77,862–$98,338 and $63,332, respectively, and were not cost-effective. A reduction of 64% in the annual cost of oral PrEP would make it highly cost-effective for 50% PrEP + 90% ART. Interpretation 20% or 50% PrEP + 90% ART is cost-effective for HIV control in the presence of HIVDR. Expanded ART alone may be the optimal policy under the current limited budgets. Funding National Natural Science Foundation of China, the National S&T Major Project Foundation of China.
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Karunaianantham R, Nesa Kumar M, Gopalan B, Haribabu H, Hanna LE, Sanjeeva G, Reddy D, Shet A, Swaminathan S, Padmapriyadarsini C. Molecular Characterization of the pol Gene of Vertically Transmitted HIV-1 Strains in Children with Virological Failure. AIDS Res Hum Retroviruses 2022; 38:491-496. [PMID: 35302390 DOI: 10.1089/aid.2021.0227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
HIV-1 pol gene sequences were analyzed from 77 HIV-1 positive children infected perinatally and exhibiting virological failure (VF). Viral subtyping, phylogenetic analysis, and genotypic drug resistance analysis were carried out on samples collected before start of anti retroviral treatment (ART) (baseline, BL), and at 12 months post-ART initiation (M12). Subtype C was found to be most predominant, seen in 75 of the 77 (97.4%) children. The level of pretreatment drug resistance (PDR) was 14% among these children. At BL, K103N (5), E138A/G (4), and M184V (3) were the most common mutations. At M12 the prevalence of any resistance-associated mutation (RAM) (acquired drug resistance/ADR) was 81.8% (63/77). Dual class resistance mutations were seen in 64% (49/77) of children. M184V/I, K103N/S, and Y181C were the most commonly occurring mutations, seen in 76%, 51%, and 36% children. RAMs to the second-generation non-nucleoside reverse transcriptase inhibitors (NNRTI), etravirine (ETR) and rilpivirine (RPV), were seen in 40.2% (31/77) and 48.05% (37/77) of the children, respectively. Our findings reveal similar prevalence rates of PDR and ADR in children with VF as reported in other studies. Occurrence of ETR and RPV resistance associated mutations (RAMs) is of concern and highlights the need for timely switch of regimens guided by genotypic resistance testing in perinatally infected children from India.
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Affiliation(s)
| | | | - Bindu Gopalan
- Division of Microbiology/Infectious Diseases Unit, St. Johns Research Institute, Bangalore, India
| | | | | | - G.N. Sanjeeva
- Department of Pediatrics, Indira Gandhi Institute of Child Health, Bangalore, India
| | - Devarajulu Reddy
- ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Anita Shet
- Division of Microbiology/Infectious Diseases Unit, St. Johns Research Institute, Bangalore, India
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Soumya Swaminathan
- ICMR-National Institute for Research in Tuberculosis, Chennai, India
- Public Health Division, World Health Organization, Geneva, Switzerland
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Gaballah A, Ghazal A, Metwally D, Emad R, Essam G, Attia NM, Amer AN. Mutation patterns, cross resistance and virological failure among HIV type-1 patients in Alexandria, Egypt. Future Virol 2022. [DOI: 10.2217/fvl-2021-0279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: The main purpose of this cross-sectional study was to detect the prevalence of drug resistance mutations related to nonnucleoside/nucleoside reverse transcriptase inhibitors (NNRTIs/NRTIs) and protease inhibitors (PIs). Patients & methods: Patients (n = 45) with HIV type-1 were recruited, 30 of whom were treatment naive and 15 treatment experienced. A partial pol gene covering the protease/reverse transcriptase (PRRT) region was amplified and then sequenced by the Sanger method. Results & conclusion: The most common NNRTI/NRTI-related mutations were ‘V179I (24%) and K103N (14.3%)’ and ‘M41L and V75M’ (14.3% each). M36I and H69K were the most prevalent PI-related mutations (86% each). The results of the current study serve as an initial crucial step in defining the overall prevalence of HIV type-1 drug resistance in Egypt.
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Affiliation(s)
- Ahmed Gaballah
- Microbiology Department, Medical Research Institute, Alexandria University, Egypt
| | - Abeer Ghazal
- Microbiology Department, Medical Research Institute, Alexandria University, Egypt
| | - Dalia Metwally
- Microbiology Department, Medical Research Institute, Alexandria University, Egypt
| | - Rasha Emad
- Alexandria Main University Hospital, Alexandria University, Egypt
| | - Ghada Essam
- Microbiology & Immunology Department, Faculty of Pharmacy & Drug Manufacturing, Pharos University, Egypt
| | - Nancy M Attia
- Microbiology Department, Medical Research Institute, Alexandria University, Egypt
| | - Ahmed N Amer
- Microbiology & Immunology Department, Faculty of Pharmacy & Drug Manufacturing, Pharos University, Egypt
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85
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Bateman M, Wolf A, Chimukangara B, Brust JCM, Lessells R, Amico R, Boodhram R, Singh N, Orrell C, Friedland G, Naidoo K, Padayatchi N, O'Donnell MR. Adherence measured using electronic dose monitoring is associated with emergent antiretroviral resistance and poor outcomes in patients co-infected with HIV/AIDS and multidrug-resistant tuberculosis. Clin Infect Dis 2022; 75:1489-1496. [PMID: 35352097 PMCID: PMC9617578 DOI: 10.1093/cid/ciac232] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Medication adherence is known to challenge treatment of HIV/AIDS and multidrug-resistant tuberculosis (MDR-TB). We hypothesized that electronic dose adherence monitoring (EDM) would identify an ART adherence threshold for emergent ART resistance and predict treatment outcomes in patients with MDR-TB and HIV on ART and bedaquiline-containing TB regimens. METHODS A prospective cohort of adults with MDR-TB and HIV, on ART and initiating MDR-TB treatment with bedaquiline, were enrolled at a public TB referral hospital in KwaZulu-Natal, South Africa (PRAXIS Study, Clinicaltrials.gov NCT03162107). Participants received separate EDM devices measuring adherence to bedaquiline and ART (nevirapine or lopinavir/ritonavir). Adherence was calculated cumulatively over six months. Participants were followed through completion of MDR-TB treatment. HIV genome sequencing was performed at baseline, 2 and 6 months on samples with HIV RNA ≥1000 copies/mL. FINDINGS From November 2016 through February 2018, 198 MDR-TB and HIV co-infected participants were enrolled and followed (median 17.2 months, IQR 12.2 - 19.6). Eleven percent had baseline ART resistance mutations, and 7.5% developed emergent ART resistance at 6 months. ART adherence was independently associated with both emergent ART resistance and mortality. Modeling identified a significant (p<0.001), but linear association between ART adherence and emergent resistance, suggesting a strong association without a specific threshold. INTERPRETATION Our findings highlight the need for ART resistance testing, especially in MDR-TB HIV co-infected patients, which is currently not standard of care in resource-limited settings. Despite short follow-up duration, reduced ART adherence was significantly associated with emergent resistance and increased mortality.
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Affiliation(s)
- Mark Bateman
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Allison Wolf
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Benjamin Chimukangara
- Critical Care Medicine Department, NIH Clinical Center, Bethesda, Maryland, USA.,CAPRISA MRC- HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa
| | - James C M Brust
- Department of Medicine, Albert Einstein College of Medicine, New York, NY, USA
| | - Richard Lessells
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), School of Laboratory Medicine & Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Rivet Amico
- Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Resha Boodhram
- CAPRISA MRC- HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa
| | - Nalini Singh
- King Dinuzulu Hospital Complex, Durban, South Africa
| | | | | | - Kogieleum Naidoo
- CAPRISA MRC- HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa
| | - Nesri Padayatchi
- CAPRISA MRC- HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa
| | - Max R O'Donnell
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA.,CAPRISA MRC- HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa
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86
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Gare J, Toto B, Pokeya P, Le LV, Dala N, Lote N, John B, Yamba A, Soli K, DeVos J, Paulin H, Wagar N, Zheng DP, Nishijima T, Boas P, Kelly-Hanku A, Gurung A. High prevalence of pre-treatment HIV drug resistance in Papua New Guinea: findings from the first nationally representative pre-treatment HIV drug resistance study. BMC Infect Dis 2022; 22:266. [PMID: 35305571 PMCID: PMC8934451 DOI: 10.1186/s12879-022-07264-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 03/08/2022] [Indexed: 11/12/2022] Open
Abstract
Background Determining the prevalence of pre-treatment HIV drug resistance (PDR) is important to assess the effectiveness of first-line therapies. To determine PDR prevalence in Papua New Guinea (PNG), we conducted a nationally representative survey. Methods We used a two-stage cluster sampling method to recruit HIV treatment initiators with and without prior exposure to antiretroviral therapies (ART) in selected clinics. Dried blood spots were collected and tested for PDR. Results A total of 315 sequences were available for analysis. The overall PDR prevalence rate was 18.4% (95% CI 13.8–24.3%). The prevalence of PDR to non-nucleoside analog reverse-transcriptase inhibitors (NNRTIs) was 17.8% (95% CI 13.6–23.0%) and of PDR to nucleoside reverse transcriptase inhibitors (NRTIs) was 6.3% (95% CI 1.6–17.1%). The PDR prevalence rate among people reinitiating ART was 42.4% (95% CI 29.1–56.4%). Conclusions PNG has a high PDR prevalence rate, especially to NNRTI-based first-line therapies. Our findings suggest that removing NNRTIs as part of first-line treatment is warranted and will lead to improving viral suppression rates in PNG.
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87
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Liu M, He XQ, Deng RN, Tang SQ, Harypursat V, Lu YQ, He K, Huo Q, Yang HH, Liu Q, Chen YK. Pretreatment drug resistance in people living with HIV: A large retrospective cohort study in Chongqing, China. HIV Med 2022; 23 Suppl 1:95-105. [PMID: 35293098 PMCID: PMC9311700 DOI: 10.1111/hiv.13253] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2022] [Indexed: 12/24/2022]
Abstract
Objectives The emergence of pretreatment drug resistance (PDR) caused by increased usage of antiretroviral therapy (ART) represents a significant challenge to HIV management. In this study, we evaluated the prevalence of PDR in people living with HIV (PLWH) in Chongqing, China. Methods We retrospectively collected the data of 1110 ART‐naïve PLWH in Chongqing from January 1, 2018 to June 30, 2021. HIV‐1 genotypes and drug resistance were analyzed using the HIV‐1 pol sequence. Risk factors associated with PDR were evaluated via the logistic regression model. Results Nine genotypes were detected among 1110 participants, with CRF07_BC (55.68%) being the dominant genotype, followed by CRF01_AE (21.44%), CRF08_BC (14.14%), and other genotypes (8.74%). Of all the participants, 24.14% exhibited drug resistance mutations (DRMs). The predominant DRMs for non‐nucleoside reverse transcriptase inhibitors (NNRTIs) and nucleoside reverse transcriptase inhibitors (NRTIs) were V179D/E/A/DIN (13.60%) and M184V/I (1.44%), respectively, whereas only two major DRMs (M46L and I54L) were identified for protease inhibitors (PIs). The total prevalence of PDR was 10.54%, with 2.43%, 7.66%, and 1.71% participants exhibiting PDR to NRTIs, NNRTIs, and PIs, respectively. Furthermore, female PLWH, delays in ART initiation, and the CRF08_BC genotype were associated with a higher risk of PDR. Conclusions Our study provides the first large cohort data on the prevalence of PDR in Chongqing, China. HIV‐1 genotypes are diverse and complex, with a moderate level of PDR, which does not reach the threshold for the initiation of a public health response. Nevertheless, continuous surveillance of PDR is both useful and advisable.
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Affiliation(s)
- Min Liu
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
| | - Xiao-Qing He
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
| | - Ren-Ni Deng
- Department of Clinical Laboratory, Chongqing Public Health Medical Center, Chongqing, China
| | - Sheng-Quan Tang
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
| | - Vijay Harypursat
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
| | - Yan-Qiu Lu
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
| | - Kun He
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
| | - Qin Huo
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
| | - Hong-Hong Yang
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
| | - Qian Liu
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
| | - Yao-Kai Chen
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China.,Department of Clinical Laboratory, Chongqing Public Health Medical Center, Chongqing, China
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88
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Kiekens A, Dierckx de Casterlé B, Pellizzer G, Mosha IH, Mosha F, Rinke de Wit TF, Sangeda RZ, Surian A, Vandaele N, Vranken L, Killewo J, Jordan M, Vandamme AM. Exploring the mechanisms behind HIV drug resistance in sub-Saharan Africa: conceptual mapping of a complex adaptive system based on multi-disciplinary expert insights. BMC Public Health 2022; 22:455. [PMID: 35255842 PMCID: PMC8899794 DOI: 10.1186/s12889-022-12738-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/08/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND HIV drug resistance (HIVDR) continues to threaten the effectiveness of worldwide antiretroviral therapy (ART). Emergence and transmission of HIVDR are driven by several interconnected factors. Though much has been done to uncover factors influencing HIVDR, overall interconnectedness between these factors remains unclear and African policy makers encounter difficulties setting priorities combating HIVDR. By viewing HIVDR as a complex adaptive system, through the eyes of multi-disciplinary HIVDR experts, we aimed to make a first attempt to linking different influencing factors and gaining a deeper understanding of the complexity of the system. METHODS We designed a detailed systems map of factors influencing HIVDR based on semi-structured interviews with 15 international HIVDR experts from or with experience in sub-Saharan Africa, from different disciplinary backgrounds and affiliated with different types of institutions. The resulting detailed system map was conceptualized into three main HIVDR feedback loops and further strengthened with literature evidence. RESULTS Factors influencing HIVDR in sub-Saharan Africa and their interactions were sorted in five categories: biology, individual, social context, healthcare system and 'overarching'. We identified three causal loops cross-cutting these layers, which relate to three interconnected subsystems of mechanisms influencing HIVDR. The 'adherence motivation' subsystem concerns the interplay of factors influencing people living with HIV to alternate between adherence and non-adherence. The 'healthcare burden' subsystem is a reinforcing loop leading to an increase in HIVDR at local population level. The 'ART overreliance' subsystem is a balancing feedback loop leading to complacency among program managers when there is overreliance on ART with a perceived low risk to drug resistance. The three subsystems are interconnected at different levels. CONCLUSIONS Interconnectedness of the three subsystems underlines the need to act on the entire system of factors surrounding HIVDR in sub-Saharan Africa in order to target interventions and to prevent unwanted effects on other parts of the system. The three theories that emerged while studying HIVDR as a complex adaptive system form a starting point for further qualitative and quantitative investigation.
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Affiliation(s)
- Anneleen Kiekens
- Department of Microbiology, Immunology and Transplantation, Clinical and Epidemiological Virology, Institute for the Future, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium.
| | | | | | - Idda H Mosha
- Department of Behavioural Sciences, Muhimbili University of Health and Allied Sciences, P.O Box 65015, Dar es Salaam, Tanzania
| | - Fausta Mosha
- Ministry of Health Community Development Gender Elderly and Children, Dar es Salaam, Tanzania
| | - Tobias F Rinke de Wit
- Amsterdam Instiute for Global Health and Development (AIGHD), Amsterdam, the Netherlands
| | - Raphael Z Sangeda
- Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, P.O Box 65012, Dar es Salaam, Tanzania
| | - Alessio Surian
- FISPPA Department, Università Degli Studi Di Padova, 35139, Padova, Italy
| | - Nico Vandaele
- Faculty of Economics and Business, Access To Medicine Research Center, KU Leuven, Leuven, Belgium
| | - Liesbet Vranken
- Department of Earth and Environmental Sciences, Division of Bioeconomics, KU Leuven, Leuven, Belgium
| | - Japhet Killewo
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Michael Jordan
- Tufts University School of Medicine, Boston, USA
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, USA
- Tufts Center for Tufts Center for Integrated Management of Antimicrobial Resistance (CIMAR), Boston, USA
| | - Anne-Mieke Vandamme
- Department of Microbiology, Immunology and Transplantation, Clinical and Epidemiological Virology, Institute for the Future, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
- Center for Global Health and Tropical Medicine, Unidade de Microbiologia, Instituto de Higiene E Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
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89
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Ogola B, Matume ND, Mavhandu-Ramarumo LG, Tebit DM, Bessong PO. Drug Resistance Mutations in a Population Before Antiretroviral Therapy Initiation in Northern South Africa. AIDS Res Hum Retroviruses 2022; 38:248-256. [PMID: 34107774 DOI: 10.1089/aid.2021.0026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
South Africa introduced the "diagnose and treat" universal HIV treatment program in September 2016. This program enables all identified HIV-positive patients to immediately start first-line antiretroviral therapy (ART). However, the presence of drug-resistant (DR) viruses in the drug-naive population complicates the choice of ART. We used next-generation sequencing (NGS) to determine the prevalence and diversity of HIV DR mutations in patients entering HIV treatment programs in northern South Africa. RNA was isolated from plasma of drug-naive HIV-1-infected patients. Using reverse transcriptase polymerase chain reaction, the HIV-1-pol gene comprising the complete protease (PR) and the first 900 bp of reverse transcriptase (RT) was amplified and sequenced on an Illumina MiniSeq platform. Consensus sequences were derived at >20% threshold and at >5% threshold using Geneious PRIME® software version 2020.1.2. HIV-1 surveillance drug resistance mutations (SDRM) were inferred using Calibrated Population Resistance tool in HIV Drug Resistance Database. Viral subtypes were determined using REGA and RIP genotyping tools. The HIV PR/RT region was successfully sequenced from 241 patients. From these, 23 (9.5%) had at least one SDRM detected at >20% threshold, with a prevalence of 9.5% (n = 18), 3% (n = 7), and 0.4% (n = 1) for non-nucleoside reverse transcriptase inhibitors (NNRTI), nucleoside reverse transcriptase inhibitors (NRTI), and protease inhibitors (PI), respectively. The number of patients with SDRM increased to 31 (12.9%) when minority variants were accounted for at >5% threshold. The most frequent SDRMs based on drug class were; K103N (7.9%-NNRTI), K65R (2.5%-NRTI), and D30N (0.8%-PI). Four cases of dual NRTI/NNRTI mutations were identified. All consensus sequences were subtype C, except three, which were C/A1, C/F1, and C/G recombinants. NGS analysis confirms that individuals entering HIV treatment programs in northern South Africa, habor moderate levels of SDRM, including cases of dual-class drug resistance. Further SDRM studies may be required to better understand resistance in the drug-naive population in the era of "diagnose and treat" in Limpopo Province, South Africa.
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Affiliation(s)
- Bixa Ogola
- HIV/AIDS & Global Health Research Program, University of Venda, Thohoyandou, South Africa
| | - Nontokozo D. Matume
- HIV/AIDS & Global Health Research Program, University of Venda, Thohoyandou, South Africa
| | | | - Denis M. Tebit
- HIV/AIDS & Global Health Research Program, University of Venda, Thohoyandou, South Africa
- Global Biomed Scientific LLC, PO Box 2368, Forest, VA 24551, USA
| | - Pascal O. Bessong
- HIV/AIDS & Global Health Research Program, University of Venda, Thohoyandou, South Africa
- Center for Global Health Equity, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
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90
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Dat VQ, Anh NTL, Van Nghia K, Linh NT, Thu HHK, Tam TTM, Ton T, Anh LQ, Phuc ND, Huong PTT, Nhan DT, Hai NH, Bertagnolio S, Crisp AM, Inzaule S, Dean NE, Jordan MR, Nguyen VTT. The prevalence of pre-treatment and acquired HIV drug resistance in Vietnam: a nationally representative survey, 2017-2018. J Int AIDS Soc 2022; 25:e25857. [PMID: 35194954 PMCID: PMC8864494 DOI: 10.1002/jia2.25857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 11/29/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction Monitoring the population‐level emergence and transmission of HIV drug resistance (HIVDR) is necessary for supporting public health programmes. This study provides a nationally representative prevalence estimate of HIVDR in people initiating antiretroviral therapy (ART) and estimates of acquired HIVDR and viral load (VL) suppression in people who have received it for 12 or ≥48 months in Vietnam. Methods The study was conducted between September 2017 and March 2018 following World Health Organization guidance. Thirty ART clinics were randomly sampled using probability proportional to size sampling from a total of 367 ART clinics in the country. Results and Discussion In total, 409 patients initiating ART were enrolled into the survey of pre‐treatment HIVDR. The prevalence of any pre‐treatment HIVDR was 5.8% (95% CI 3.4–9.5%), and the prevalence of non‐nucleoside reverse transcriptase inhibitor resistance was 3.4% (95% CI 1.8–6.2%). Four hundred twenty‐nine patients on ART for 12±3 months and 723 patients on ART for ≥48 months were enrolled into the surveys of acquired HIVDR. The prevalence of VL suppression (defined as <1000 copies/ml) in patients on ART for 12±3 and ≥48 months was 95.5% (95% CI 91.3–97.8%) and 96.1% (95% CI 93.2–97.8%), respectively. Among individuals with viral non‐suppression, any HIVDR was detected in 11/14 (weighted prevalence 74.3%) of those on ART for 12±3 months and in 24/27 (weighted prevalence 88.5%) of those receiving ART for ≥48 months. Conclusions This nationally representative study of HIVDR found high levels of VL suppression among those on ART for 12 and ≥48 months. Overall, high levels of VL suppression at both time points suggested good adherence among patients receiving ART and quality of treatment services in Vietnam. Clinical Trial Number Not applicable
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Affiliation(s)
- Vu Quoc Dat
- Department of Infectious Diseases, Hanoi Medical University, Hanoi, Vietnam
| | | | - Khuu Van Nghia
- Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | | | | | | | - Tran Ton
- Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Luong Que Anh
- Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nguyen Duy Phuc
- Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | | | - Do Thi Nhan
- Vietnam Administration for HIV/AIDS Control, Hanoi, Vietnam
| | - Nguyen Huu Hai
- Vietnam Administration for HIV/AIDS Control, Hanoi, Vietnam
| | | | - Amy M Crisp
- Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | | | - Natalie E Dean
- Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Michael R Jordan
- Division of Geographic Medicine, Tufts Medical Center, Boston, Massachusetts, USA.,Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA.,Levy Center for Integrated Management of Antimicrobial Resistance (CIMAR), Boston, Massachusetts, USA
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91
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Spooner E, Reddy T, Mchunu N, Reddy S, Daniels B, Ngomane N, Luthuli N, Kiepiela P, Coutsoudis A. Point-of-care CD4 testing: Differentiated care for the most vulnerable. J Glob Health 2022; 12:04004. [PMID: 35136596 PMCID: PMC8818294 DOI: 10.7189/jogh.12.04004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background South Africa, with the highest burden of HIV infection globally, has made huge strides in its HIV/ART programme, but AIDS deaths have not decreased proportionally to ART uptake. Advanced HIV disease (CD4 < 200 cells/mm3) persists, and CD4 count testing is being overlooked since universal test-and-treat was implemented. Point-of-care CD4 testing could address this gap and assure differentiated care to these vulnerable patients with low CD4 counts. Methods A time randomised implementation trial was conducted, enrolling 603 HIV positive non-ART, not pregnant patients at a primary health care clinic in Durban, South Africa. Weeks were randomised to either point-of-care CD4 testing (n = 305 patients) or standard-of-care central laboratory CD4 testing (n = 298 patients) to assess the proportion initiating ART at 3 months. Cox regression, with robust standard errors adjusting for clustering by week, were used to assess the relationship between treatment initiation and arm. Results Among the 578 (299 point-of-care and 279 standard-of-care) patients eligible for analysis, there was no significant difference in the number of eligible patients initiating ART within 3 months in the point-of-care (73%) and the standard-of-care (68%) groups (P = 0.112). The time-to-treat analysis was not significantly different in patients with CD4 counts of 201-500 cells/mm3 which could have been due to appointment scheduling to cope with the large burden of cases. However, in patients with advanced HIV disease (CD4 < 200cells/mm3) 65% more patients started ART earlier in the point-of-care group (HR 1.65 (95% confidence interval (CI) = 0.99-2.75; P = 0.052) compared to the standard-of-care group. Conclusions Point-of-care testing decreased time-to-treatment in those with advanced HIV disease. With universal test and treat for HIV, rollout of simple point-of-care CD4 testing would ensure early diagnosis of advanced HIV disease and facilitate differentiated care for these vulnerable patients as per the World Health Organisation 2020 target product profile for point-of-care CD4 testing. Trial registration ISRCTN14220457.
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Affiliation(s)
- Elizabeth Spooner
- Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
- South African Medical Research Council, HIV Prevention Research Unit, Durban, South Africa
| | - Tarylee Reddy
- South African Medical Research Council, Biostatistics Unit, Durban, South Africa
| | - Nobuhle Mchunu
- South African Medical Research Council, Biostatistics Unit, Durban, South Africa
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | | | - Brodie Daniels
- South African Medical Research Council, HIV Prevention Research Unit, Durban, South Africa
| | | | | | | | - Anna Coutsoudis
- Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
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92
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High Level of Pre-Treatment HIV-1 Drug Resistance and Its Association with HLA Class I-Mediated Restriction in the Pumwani Sex Worker Cohort. Viruses 2022; 14:v14020273. [PMID: 35215866 PMCID: PMC8879707 DOI: 10.3390/v14020273] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 01/08/2023] Open
Abstract
Background: We analyzed the prevalence of pre-antiretroviral therapy (ART) drug resistance mutations (DRMs) in a Kenyan population. We also examined whether host HLA class I genes influence the development of pre-ART DRMs. Methods: The HIV-1 proviral DNAs were amplified from blood samples of 266 ART-naïve women from the Pumwani Sex Worker cohort of Nairobi, Kenya using a nested PCR method. The amplified HIV genomes were sequenced using next-generation sequencing technology. The prevalence of pre-ART DRMs was investigated. Correlation studies were performed between HLA class I alleles and HIV-1 DRMs. Results: Ninety-eight percent of participants had at least one DRM, while 38% had at least one WHO surveillance DRM. M184I was the most prevalent clinically important variant, seen in 37% of participants. The DRMs conferring resistance to one or more integrase strand transfer inhibitors were also found in up to 10% of participants. Eighteen potentially relevant (p < 0.05) positive correlations were found between HLA class 1 alleles and HIV drug-resistant variants. Conclusions: High levels of HIV drug resistance were found in all classes of antiretroviral drugs included in the current first-line ART regimens in Africa. The development of DRMs may be influenced by host HLA class I-restricted immunity.
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93
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Okwir M, Link A, Rhein J, Obbo JS, Okello J, Nabongo B, Alal J, Meya D, Bohjanen PR. High Burden of Cryptococcal Meningitis Among ART-Experienced HIV-infected Patients in Northern Uganda in the era of “Test and Treat”: Implications for Cryptococcal Screening Programs. Open Forum Infect Dis 2022; 9:ofac004. [PMID: 35111875 PMCID: PMC8802797 DOI: 10.1093/ofid/ofac004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/06/2022] [Indexed: 11/12/2022] Open
Abstract
Background The impact of the “test and treat” program for human immunodeficiency virus (HIV) treatment in rural areas of Uganda on cryptococcal antigen (CrAg) screening or cryptococcal meningitis (CM) is poorly understood. Methods We retrospectively evaluated clinical factors in 212 HIV-infected patients diagnosed with CM from February of 2017 to November of 2019 at Lira Regional Referral Hospital in northern Uganda. Results Among 212 patients diagnosed with CM, 58.5% were male. Median age was 35 years; CD4 count and HIV viral load (VL) were 86 cells/μL and 9463 copies/mL, respectively. Only 10% of patients had a previous history of CM. We found that 190 of 209 (90.9%) patients were ART experienced and 19 (9.1%) were ART naive. Overall, 90 of 212 (42.5%) patients died while hospitalized (median time to death, 14 days). Increased risk of death was associated with altered mental status (hazard ratio [HR], 6.6 [95% confidence interval {CI}, 2.411–18.219]; P ≤ .0001) and seizures (HR, 5.23 [95% CI, 1.245–21.991]; P = .024). Conclusions Current guidelines recommend CrAg screening based on low CD4 counts for ART-naive patients and VL or clinical failure for ART-experienced patients. Using current guidelines for CrAg screening, some ART-experienced patients miss CrAg screening in resource-limited settings, when CD4 or VL tests are unavailable. We found that the majority of HIV-infected patients with CM were ART experienced (90.9%) at presentation. The high burden of CM in ART-experienced patients supports a need for improved CrAg screening of ART-exposed patients.
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Affiliation(s)
- Mark Okwir
- Department of Medicine, Lira University, Lira, Uganda
- Lira Regional Referral Hospital, Lira, Uganda
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Abigail Link
- Department of Medicine, Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, USA
- University of Washington, Seattle, USA
| | - Joshua Rhein
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
- Department of Medicine, Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, USA
| | | | | | | | - Jimmy Alal
- Lira Regional Referral Hospital, Lira, Uganda
| | - David Meya
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
- Department of Medicine, Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, USA
| | - Paul R Bohjanen
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
- Department of Medicine, Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, USA
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94
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Garcia C, Rehman N, Lawson DO, Djiadeu P, Mbuagbaw L. Developing Reporting Guidelines for Studies of HIV Drug Resistance Prevalence: A Protocol for a Mixed-methods Study (Preprint). JMIR Res Protoc 2022; 11:e35969. [PMID: 35559984 PMCID: PMC9143765 DOI: 10.2196/35969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/10/2022] [Accepted: 04/25/2022] [Indexed: 11/14/2022] Open
Abstract
Background HIV drug resistance is a global health problem that limits the effectiveness of antiretroviral therapy. Adequate surveillance of HIV drug resistance is challenged by heterogenous and inadequate data reporting, which compromises the accuracy, interpretation, and usability of prevalence estimates. Previous research has found that the quality of reporting in studies of HIV drug resistance prevalence is low, and thus better guidance is needed to ensure complete and uniform reporting. Objective This paper contributes to the process of developing reporting guidelines for prevalence studies of HIV drug resistance by reporting the methodology used in creating a reporting item checklist and generating key insights on items that are important to report. Methods We will conduct a sequential explanatory mixed methods study among authors and users of studies of HIV drug resistance. The two-phase design will include a cross-sectional electronic survey (quantitative phase) followed by a focus group discussion (qualitative phase). Survey participants will rate the essentiality of various reporting items. This data will be analyzed using content validity ratios to determine the items that will be retained for focus group discussions. Participants in these discussions will revise the items and any additionally suggested items and settle on a complete reporting item checklist. We will also conduct a thematic analysis of the group discussions to identify emergent themes regarding the agreement process. Results As of November 2021, data collection for both phases of the study is complete. In July 2021, 51 participants had provided informed consent and completed the electronic survey. In October 2021, focus group discussions were held. Nine participants in total participated in two virtual focus group discussions. As of May 2022, data are being analyzed. Conclusions This study supports the development of a reporting checklist for studies of HIV drug resistance by achieving agreement among experts on what items should be reported in these studies. The results of this work will be refined and elaborated on by a writing committee of HIV drug resistance experts and external reviewers to develop finalized reporting guidelines. International Registered Report Identifier (IRRID) DERR1-10.2196/35969
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Affiliation(s)
- Cristian Garcia
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Nadia Rehman
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Daeria O Lawson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Pascal Djiadeu
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
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95
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Kalemeera F, Ndevahoma S, Mubita M, Godman B. Evaluation of Namibia's antiretroviral therapy guidelines' recommendations for switching from first-line to second-line, using predictors of first-line treatment failure: an exploratory study. Expert Rev Anti Infect Ther 2022; 20:915-921. [PMID: 34878350 DOI: 10.1080/14787210.2022.2015325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The objective of this study was to find out the extent to which the antiretroviral therapy (ART) switching guidelines were complied with and to assess whether immediate switching from first- to second-line ART would have been appropriate than attempting to comply with the guidelines. METHODS A case-control study. Cases and controls were patients on second- and first-line ART, respectively. Regression analysis was used to identify factors that were associated with switching to second-line ART. Confidence level was 95% and significance at a p-value <0.05. RESULTS 81 cases and 102 controls were included. VLs at six and 9 months were implemented for 8.2% and 2.7%, respectively. Switching predictors were poor adherence (adjusted Hazard Ratio [aHR] = 20.3 (p = 0.013); a first VL >1000 copies/ml (aHR = 20.2), <0.001); opportunistic infections (aHR = 12.9, p = 0.006); male gender (aHR = 5.2, p = 0.003); and lack of adherence counseling (aHR = 3.8 p = 0.024). CONCLUSION AVL >1000 copies/ml was a predictor of switching. New local research is underway, with a large number of patients, to assess whether this finding applies to the dolutegravir-based regimens.
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Affiliation(s)
- F Kalemeera
- School of Pharmacy, Faculty of Health Sciences, University of Namibia Windhoek Namibia
| | - St Ndevahoma
- School of Pharmacy, Faculty of Health Sciences, University of Namibia Windhoek Namibia
| | - M Mubita
- School of Pharmacy, Faculty of Health Sciences, University of Namibia Windhoek Namibia
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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96
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Li R, Song C, Chen D, Li C, Hao Y, Zeng H, Han J, Zhao H. Prevalence of Transmitted Drug Resistance among ART-Naïve HIV-Infected Individuals, Beijing, 2015-2018. J Glob Antimicrob Resist 2022; 28:241-248. [DOI: 10.1016/j.jgar.2022.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 12/02/2021] [Accepted: 01/20/2022] [Indexed: 11/16/2022] Open
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97
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Abstract
PURPOSE OF REVIEW We reviewed evidence concerning the novel nonnucleoside reverse transcriptase inhibitor doravirine, aiming to identify situations where it may be selected in preference to integrase inhibitors. RECENT FINDINGS Doravirine is licenced for the treatment of HIV-1 in North America and Europe. In two multicentre randomized controlled trials, noninferiority with comparator drugs efavirenz and darunavir/ritonavir was observed at 96 weeks. Doravirine is associated with a lower incidence of neuropsychiatric side effects relative to efavirenz, and favourable lipid changes relative to darunavir over 96 weeks. A lower incidence of weight gain, relative to indirect comparisons with integrase inhibitors, was observed. Doravirine has a high genetic barrier to resistance with retained activity in the presence of single NNRTI mutations K103N, Y181C and G190A. Primary drug resistance is infrequent and may be higher in South Africa relative to European populations. Doravirine may be used in renal or hepatic impairment and has a low potential for drug-drug interactions. SUMMARY Doravirine is a well tolerated and effective agent in ART-naive patients. Direct comparison with integrase inhibitors, and evidence on the outcomes of treatment with doravirine in the presence of prior NNRTI experience are required to better elucidate which patients will benefit most from doravirine therapy.
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Affiliation(s)
| | - Saye Khoo
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
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98
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McCluskey SM, Pepperrell T, Hill A, Venter WDF, Gupta RK, Siedner MJ. Adherence, resistance, and viral suppression on dolutegravir in sub-Saharan Africa: implications for the TLD era. AIDS 2021; 35:S127-S135. [PMID: 34848579 PMCID: PMC8647784 DOI: 10.1097/qad.0000000000003082] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Dolutegravir (DTG) is now a component of preferred first-line antiretroviral therapy (ART) worldwide. ADVANCE and NAMSAL were two landmark clinical trials conducted exclusively in sub-Saharan Africa, which studied the effectiveness of DTG-based first-line regimens for ART-naive individuals. In this review, we examine the data from these studies to consider the contributions of adherence and HIV drug resistance to treatment failure on DTG-based ART, as compared with efavirenz (EFV)-based ART, which has a lower genetic barrier to resistance. We also discuss the implications of virologic failure on DTG and consolidate currently available data to conclude with recommendations for virologic monitoring on DTG-based ART.
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Affiliation(s)
- Suzanne M McCluskey
- Medical Practice Evaluation Center
- Division of Infectious Diseases, Massachusetts General Hospital
- Harvard Medical School, Boston, MA, USA
| | | | - Andrew Hill
- Department of Translational Medicine, Liverpool University, Liverpool, United Kingdom
| | - Willem D F Venter
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
| | - Ravindra K Gupta
- Africa Health Research Institute, Durban, South Africa
- Cambridge University, Cambridge, United Kingdom
| | - Mark J Siedner
- Medical Practice Evaluation Center
- Division of Infectious Diseases, Massachusetts General Hospital
- Harvard Medical School, Boston, MA, USA
- Africa Health Research Institute, Durban, South Africa
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99
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Asif S, Baxevanidi E, Hill A, Venter WDF, Fairlie L, Masenya M, Serenata C, Sokhela S, Chandiwana N. The predicted risk of adverse pregnancy outcomes as a result of treatment-associated obesity in a hypothetical population receiving tenofovir alafenamide/emtricitabine/dolutegravir, tenofovir disoproxil fumarate/emtricitabine/dolutegravir or tenofovir disoproxil fumarate/emtricitabine/efavirenz. AIDS 2021; 35:S117-S125. [PMID: 34261099 DOI: 10.1097/qad.0000000000003020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Integrase inhibitors, including dolutegravir (DTG), are associated with weight gain and obesity, especially when combined with tenofovir alafenamide (TAF). Obesity increases the risk of adverse pregnancy outcomes (APOs). This study aimed to predict the risk of APOs caused by treatment-associated obesity, using a hypothetical sample based on the ADVANCE trial. DESIGN Risk prediction. METHODS Firstly, a meta-analysis was performed to determine the relative risk (RR) for APOs in women with obese (≥30) versus normal prepregnancy BMIs (18.5-24.9). For the hypothetical sample, 3000 nonpregnant women with normal BMIs at Week 0 of treatment were evenly allocated across the following treatment arms: TAF/FTC+DTG, TDF/FTC+DTG, TDF/FTC/EFV. The treatment-associated obesity rates from ADVANCE were used to calculate the number of women with obese and normal BMIs expected at Week 96 in our sample. This was combined with the APO RRs to predict the number of women at risk of APOs, in each treatment arm, assuming they conceived at Week 96. RESULTS At Week 96, the percentage of women predicted to be obese was 14.1% with TAF/FTC+DTG, 7.9% with TDF/FTC+DTG and 1.5% with TDF/FTC/EFV. The RR in women with obese versus normal BMIs was significantly higher for most APOs. Therefore, the number of women at risk of APOs was higher with TAF/FTC+DTG than TDF/FTC+DTG and TDF/FTC/EFV. For example, 11/1000 additional gestational hypertension cases were predicted with TAF/FTC+DTG, 6/1000 with TDF/FTC+DTG and 1/1000 with TDF/FTC/EFV. CONCLUSION Treatment-associated obesity increased the APO risk in women. This risk is likely to increase, as preliminary data from ADVANCE demonstrates ongoing weight gain beyond Week 96.
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Affiliation(s)
- Sumbul Asif
- Faculty of Medicine, Imperial College London, UK
| | | | - Andrew Hill
- Department of Translational Medicine, University of Liverpool, Liverpool, UK
| | | | - Lee Fairlie
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Masebole Masenya
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Celicia Serenata
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Simiso Sokhela
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nomathemba Chandiwana
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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100
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Guo C, Wu Y, Zhang Y, Liu X, Li A, Gao M, Zhang T, Wu H, Chen G, Huang X. Transmitted Drug Resistance in Antiretroviral Therapy-Naive Persons With Acute/Early/Primary HIV Infection: A Systematic Review and Meta-Analysis. Front Pharmacol 2021; 12:718763. [PMID: 34899288 PMCID: PMC8652085 DOI: 10.3389/fphar.2021.718763] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 10/12/2021] [Indexed: 11/18/2022] Open
Abstract
Background: The widespread use of antiretroviral therapy (ART) has raised concerns about the emergence of HIV transmitted drug resistance (TDR). Acute HIV infection (AHI) was the most appropriate time to detect the spread of TDR. In this meta-analysis, our purpose was to evaluate the level of TDR in ART-naive patients with primary HIV infection (PHI)/AHI/early HIV infection (EHI) and to describe the critical drug-resistant mutations. Methods: We systematically searched the literature between January 1, 2008, and April 30, 2021, in PubMed, Web of Science, Embase, and the Cochrane Library. To evaluate the overall prevalence of TDR, we extracted raw data and analyzed prevalence estimates using Stata SE. Results: The data of this meta-analysis come from 12 observational studies, covering 3,558 ART-naive individuals with PHI, AHI, or EHI. The overall prevalence of HIV-TDR is 9.3% (95% CI: 6.8%–11.8%, I2 = 81.1%, in 11 studies). The prevalence of resistance by drug class is the highest for the nonnucleoside reverse transcriptase inhibitors (NNRTIs) at 5.7% (95% CI: 2.9%–8.5%, I2 = 96.6%, in 11 studies), followed by nucleoside reverse transcriptase inhibitors (NRTIs) at 3.4% (95% CI: 1.8%–5.0%, I2 = 86.3%, in 10 studies) and protease inhibitors (PIs) at 3.3% (95% CI: 2.7%–3.9%, I2 = 15.6%, in 10 studies). The prevalence of TDR to integrase inhibitors (INIs) is 0.3% (95% CI: 0.1%–0.7%, I2 = 95.9%, in three studies), which is the lowest among all antiretroviral drugs. Conclusion: The overall prevalence of TDR is at a moderate level among AHI patients who have never received ART. This emphasizes the importance of baseline drug resistance testing for public health surveillance and guiding the choice of ART. In addition, the prevalence of TDR to NNRTIs is the highest, while the TDR to INIs is the lowest. This may guide the selection of clinical antiretroviral drugs.
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Affiliation(s)
- Chunxiang Guo
- Department of Dermatology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yaxin Wu
- Center for Infectious Disease, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Yang Zhang
- Center for Infectious Disease, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of HIV/AIDS Research, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Xinchao Liu
- Department of Infectious Disease, Peking Union Medical College Hospital, Beijing, China
| | - Aixin Li
- Center for Infectious Disease, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Meixia Gao
- Center for Infectious Disease, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Tong Zhang
- Center for Infectious Disease, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of HIV/AIDS Research, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Hao Wu
- Center for Infectious Disease, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of HIV/AIDS Research, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Guanzhi Chen
- Department of Dermatology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaojie Huang
- Center for Infectious Disease, Beijing Youan Hospital, Capital Medical University, Beijing, China
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