1
|
Kirichenko A, Kireev D, Lopatukhin A, Murzakova A, Lapovok I, Saleeva D, Ladnaya N, Gadirova A, Ibrahimova S, Safarova A, Grigoryan T, Petrosyan A, Sarhatyan T, Gasich E, Bunas A, Glinskaya I, Yurovsky P, Nurov R, Soliev A, Ismatova L, Musabaev E, Kazakova E, Rakhimova V, Pokrovsky V. Prevalence of HIV-1 drug resistance in Eastern European and Central Asian countries. PLoS One 2022; 17:e0257731. [PMID: 35061671 PMCID: PMC8782385 DOI: 10.1371/journal.pone.0257731] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/08/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Eastern Europe and Central Asia (EECA) is one of the regions where the HIV epidemic continues to grow at a concerning rate. Antiretroviral therapy (ART) coverage in EECA countries has significantly increased during the last decade, which can lead to an increase in the risk of emergence, transmission, and spread of HIV variants with drug resistance (DR) that cannot be controlled. Because HIV genotyping cannot be performed in these countries, data about HIV DR are limited or unavailable. OBJECTIVES To monitor circulating HIV-1 genetic variants, assess the prevalence of HIV DR among patients starting antiretroviral therapy, and reveal potential transmission clusters among patients in six EECA countries: Armenia, Azerbaijan, Belarus, Russia, Tajikistan, and Uzbekistan. MATERIALS AND METHODS We analyzed 1071 HIV-1 pol-gene fragment sequences (2253-3369 bp) from patients who were initiating or reinitiating first-line ART in six EECA counties, i.e., Armenia (n = 120), Azerbaijan (n = 96), Belarus (n = 158), Russia (n = 465), Tajikistan (n = 54), and Uzbekistan (n = 178), between 2017 and 2019. HIV Pretreatment DR (PDR) and drug resistance mutation (DRM) prevalence was estimated using the Stanford HIV Resistance Database. The PDR level was interpreted according to the WHO standard PDR survey protocols. HIV-1 subtypes were determined using the Stanford HIV Resistance Database and subsequently confirmed by phylogenetic analysis. Transmission clusters were determined using Cluster Picker. RESULTS Analyses of HIV subtypes showed that EECA, in general, has the same HIV genetic variants of sub-subtype A6, CRF63_02A1, and subtype B, with different frequencies and representation for each country. The prevalence of PDR to any drug class was 2.8% in Uzbekistan, 4.2% in Azerbaijan, 4.5% in Russia, 9.2% in Armenia, 13.9% in Belarus, and 16.7% in Tajikistan. PDR to protease inhibitors (PIs) was not detected in any country. PDR to nucleoside reverse-transcriptase inhibitors (NRTIs) was not detected among patients in Azerbaijan, and was relatively low in other countries, with the highest prevalence in Tajikistan (5.6%). The prevalence of PDR to nonnucleoside reverse-transcriptase inhibitors (NNRTIs) was the lowest in Uzbekistan (2.8%) and reached 11.1% and 11.4% in Tajikistan and Belarus, respectively. Genetic transmission network analyses identified 226/1071 (21.1%) linked individuals, forming 93 transmission clusters mainly containing two or three sequences. We found that the time since HIV diagnosis in clustered patients was significantly shorter than that in unclustered patients (1.26 years vs 2.74 years). Additionally, the K103N/S mutation was mainly observed in clustered sequences (6.2% vs 2.8%). CONCLUSIONS Our study demonstrated different PDR prevalence rates and DR dynamics in six EECA countries, with worrying levels of PDR in Tajikistan and Belarus, where prevalence exceeded the 10% threshold recommended by the WHO for immediate public health action. Because DR testing for clinical purposes is not common in EECA, it is currently extremely important to conduct surveillance of HIV DR in EECA due to the increased ART coverage in this region.
Collapse
Affiliation(s)
- Alina Kirichenko
- Central Research Institute of Epidemiology, Moscow, Russian Federation
| | - Dmitry Kireev
- Central Research Institute of Epidemiology, Moscow, Russian Federation
| | - Alexey Lopatukhin
- Central Research Institute of Epidemiology, Moscow, Russian Federation
| | | | - Ilya Lapovok
- Central Research Institute of Epidemiology, Moscow, Russian Federation
| | - Daria Saleeva
- Central Research Institute of Epidemiology, Moscow, Russian Federation
| | - Natalya Ladnaya
- Central Research Institute of Epidemiology, Moscow, Russian Federation
| | | | | | - Aygun Safarova
- Republic Center of the Struggle against AIDS, Baku, Azerbaijan
| | | | | | | | - Elena Gasich
- Republican Research and Practical Center for Epidemiology and Microbiology, Minsk, Belarus
| | - Anastasia Bunas
- Republican Research and Practical Center for Epidemiology and Microbiology, Minsk, Belarus
| | - Iryna Glinskaya
- Republican Center for Hygiene, Epidemiology and Public Health, Minsk, Belarus
| | - Pavel Yurovsky
- Republican Center for Hygiene, Epidemiology and Public Health, Minsk, Belarus
| | - Rustam Nurov
- Republican AIDS prevention center, Dushanbe, Tajikistan
| | - Alijon Soliev
- Republican AIDS prevention center, Dushanbe, Tajikistan
| | | | | | | | - Visola Rakhimova
- Center for development of profession qualification of medical workers, Tashkent, Uzbekistan
| | - Vadim Pokrovsky
- Central Research Institute of Epidemiology, Moscow, Russian Federation
| |
Collapse
|
2
|
Duarte HA, Babigumira JB, Enns EA, Stauffer DC, Shafer RW, Beck IA, Garrison LP, Chung MH, Frenkel LM, Bendavid E. Cost-effectiveness analysis of pre-ART HIV drug resistance testing in Kenyan women. EClinicalMedicine 2020; 22:100355. [PMID: 32490370 PMCID: PMC7256304 DOI: 10.1016/j.eclinm.2020.100355] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The prevalence of pre-treatment drug resistance (PDR) to non-nucleoside reverse-transcriptase inhibitor (NNRTI) agents is increasing in sub-Saharan Africa, which may decrease the effectiveness of efavirenz-based antiretroviral therapy (ART) programs. However, due to recent safety concerns, there has been hesitancy to replace efavirenz-based ART with dolutegravir in women of reproductive potential. Our objective was to evaluate whether PDR testing for women not initiating dolutegravir-based ART would be a cost-effective strategy to address the challenges posed by PDR. METHODS We developed an HIV drug resistance model that simulates the emergence and transmission of resistance mutations, calibrated to the Kenyan epidemic. We modeled three care strategies for PDR testing among women not initiating dolutegravir-based ART: no PDR testing, PDR testing with a low-cost point mutation assay, known as oligonucleotide ligation assay (OLA), and PDR testing with consensus sequencing. Using a health sector perspective, this model was used to evaluate the health outcomes, lifetime costs, and cost-effectiveness under each strategy over a 15-year time horizon starting in 2019. FINDINGS OLA and CS PDR testing were projected to have incremental cost-effectiveness ratios (ICER) of $10,741/QALY gained and $134,396/QALY gained, respectively, which are not cost-effective by national income standards. Viral suppression rates among women at 12 months after ART initiation were 87·8%, 89·0%, and 89·3% with no testing, OLA testing, and CS testing, respectively. PDR testing with OLA and CS were associated with a 0.5% and 0.6% reduction in incidence rate compared to no PDR testing. Initial PDR prevalence among women was 13.1% in 2019. By 2034, this prevalence was 17·6%, 17·4%, and 17·3% with no testing, OLA testing, and CS testing, respectively. INTERPRETATION PDR testing for women is unlikely to be cost-effective in Kenya whether one uses a low-cost assay, such as OLA, or consensus sequencing. FUNDING National Institutes of Health, Gilead Sciences.
Collapse
Affiliation(s)
- Horacio A Duarte
- Department of Pediatrics, Division of Infectious Diseases, University of Washington, Seattle, WA, United States
- Seattle Children's Research Institute, Seattle, WA, United States
| | - Joseph B Babigumira
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Eva A Enns
- School of Public Health, Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, United States
| | - David C Stauffer
- Department of Pediatrics, Division of Infectious Diseases, University of Washington, Seattle, WA, United States
| | - Robert W Shafer
- Department of Medicine, Stanford University, Stanford, CA, United States
| | - Ingrid A Beck
- Seattle Children's Research Institute, Seattle, WA, United States
| | - Louis P Garrison
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, WA, United States
| | | | - Lisa M Frenkel
- Department of Pediatrics, Division of Infectious Diseases, University of Washington, Seattle, WA, United States
- Seattle Children's Research Institute, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Laboratory Medicine, University of Washington, Seattle, WA, United States
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - Eran Bendavid
- Department of Medicine, Stanford University, Stanford, CA, United States
| |
Collapse
|
3
|
Inzaule SC, Rinke de Wit TF, Hamers RL, dW TFR. Does Tenofovir-containing First-line Antiretroviral Therapy Mitigate the Impact of Pretreatment Non-nucleoside Reverse Transcriptase Inhibitor Drug Resistance? Clin Infect Dis 2018; 68:2158-2160. [DOI: 10.1093/cid/ciy1070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 12/13/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Seth C Inzaule
- Amsterdam Institute for Global Health and Development, Department of Global Health, Amsterdam University Medical Center, University of Amsterdam
- Joep Lange Institute, Amsterdam, The Netherlands
| | - Tobias F Rinke de Wit
- Amsterdam Institute for Global Health and Development, Department of Global Health, Amsterdam University Medical Center, University of Amsterdam
- Joep Lange Institute, Amsterdam, The Netherlands
| | - Raph L Hamers
- Amsterdam Institute for Global Health and Development, Department of Global Health, Amsterdam University Medical Center, University of Amsterdam
- Eijkman-Oxford Clinical Research Unit, Eijkman Institute for Molecular Biology
- Faculty of Medicine, Universitas Indonesia, Jakarta
- Center for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
| | | | | |
Collapse
|