1
|
Takem EN, Coox C, Shang J, Ndongmo C, Dokubo EK. The association between HIV pretreatment drug resistance and virological outcomes in children and adults in sub-Saharan Africa: A systematic review and meta-analysis. PLoS One 2024; 19:e0300456. [PMID: 38626183 PMCID: PMC11020706 DOI: 10.1371/journal.pone.0300456] [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: 02/01/2023] [Accepted: 02/27/2024] [Indexed: 04/18/2024] Open
Abstract
INTRODUCTION Pretreatment drug resistance (PDR) could occur in antiretroviral treatment (ART) naïve individuals, those previously exposed to ART, or individuals re-initiating ARV after a long period of interruption. Few studies have shown its association with virological outcomes, although inconsistent. The objective of this review was to provide a synthesis of the association between PDR and virological outcomes (virological failure or suppression). METHODS This report is presented following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The method was subdivided into three main phases: record identification, screening, and report inclusion. Record identification consisted of an initial search with search term "HIV pretreatment drug resistance". Another search was done using terms "Pretreatment drug resistance OR pre-treatment drug resistance OR Pretreatment drug resist* OR pre-treatment drug resist* OR pretreatment antiretroviral resistance OR pretreatment medic* OR pretreatment medic* resist*" and a list of all the countries in sub-Saharan Africa. After the electronic search, studies were screened from full list based on their title and abstract and then full articles retrieved and studies were assessed based on set criteria. Inclusion criteria involved observational studies that report the association between PDR and virological failure. Data from trials that reported the association were also included. Published articles like modelling studies and reviews, and studies with data that had been previously included in the review were excluded. The Mantel Haenszel method with odds ratios was used for synthesis (meta-analyses) with the weights of each study which depends on the number of events and totals. RESULTS A total of 733 records(studies) were obtained from all database search of which 74 reported on PDR, virological outcomes in sub-Saharan Africa (SSA). Out of the 74 articles, 11 were excluded and 26 did not explicitly report data needed, and 5 did not meet the inclusion criteria. Of the remaining 32 studies, 19 studies that had complete data on the number of participants with PDR and no PDR according to virological failure (VF) were included in the metanalyses. The pooled results from eleven (13) of these studies showed those with PDR had higher odds of virological failure compared to those without PDR OR 3.64[95% CI 2.93, 4.52]. The result was similar when stratified in adults and in children. In six (6) studies that had Virological suppression (VS) as outcome, there was a reduction in the odds of VS in those with PDR compared to those without PDR, OR 0.42 (95% CI 0.30, 0.58). CONCLUSION In conclusion, this systematic review indicates that PDR increases the risk of virological failure in sub-Saharan Africa. The risk could be reduced by PDR monitoring for NNRTIs and INSTIs.
Collapse
Affiliation(s)
| | | | - Judith Shang
- Centers for Disease Control and Prevention (CDC), Cameroon
| | | | | |
Collapse
|
2
|
Abuogi L, Oyaro P, Wakjira G, Thomas KK, Scallon AJ, Mukui I, Chohan BH, Brown E, Karauki E, Yongo N, Ahmed B, Hassan SA, Wagude J, Kinywa E, Otieno L, Kingwara L, Oyaro B, Frenkel LM, John-Stewart G, Patel RC. HIV Drug Resistance Patterns and Characteristics Associated with Clinically Significant Drug Resistance among Children with Virologic Failure on Antiretroviral Treatment in Kenya: Findings from the Opt4Kids Randomized Controlled Trial. Viruses 2023; 15:2083. [PMID: 37896860 PMCID: PMC10612029 DOI: 10.3390/v15102083] [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: 08/28/2023] [Revised: 09/29/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
Increasing HIV drug resistance (DR) among children with HIV (CHIV) on antiretroviral treatment (ART) is concerning. CHIV ages 1-14 years enrolled from March 2019 to December 2020 from five facilities in Kisumu County, Kenya, were included. Children were randomized 1:1 to control (standard-of-care) or intervention (point-of-care viral load (POC VL) testing every three months with targeted genotypic drug resistance testing (DRT) for virologic failure (VF) (≥1000 copies/mL)). A multidisciplinary committee reviewed CHIV with DRT results and offered treatment recommendations. We describe DR mutations and present logistic regression models to identify factors associated with clinically significant DR. We enrolled 704 children in the study; the median age was 9 years (interquartile range (IQR) 7, 12), 344 (49%) were female, and the median time on ART was 5 years (IQR 3, 8). During the study period, 106 (15%) children had DRT results (84 intervention and 22 control). DRT detected mutations associated with DR in all participants tested, with 93 (88%) having major mutations, including 51 (54%) with dual-class resistance. A history of VF in the prior 2 years (adjusted odds ratio (aOR) 11.1; 95% confidence interval (CI) 6.3, 20.0) and less than 2 years on ART at enrollment (aOR 2.2; 95% CI 1.1, 4.4) were associated with increased odds of major DR. DR is highly prevalent among CHIV on ART with VF in Kenya. Factors associated with drug resistance may be used to determine which children should be prioritized for DRT.
Collapse
Affiliation(s)
- Lisa Abuogi
- Department of Pediatrics, University of Colorado, Denver, CO 80045, USA
| | - Patrick Oyaro
- Health Innovations Kenya (HIK), Kisumu 40100, Kenya;
- United States Agency for International Development, Washington, DC 20004, USA
| | - Garoma Wakjira
- Department of Medicine, University of Washington, Seattle, WA 98195, USA; (G.W.); (S.A.H.); (L.M.F.); (G.J.-S.); (R.C.P.)
| | - Katherine K. Thomas
- Department of Global Health, University of Washington, Seattle, WA 98105, USA; (K.K.T.); (A.J.S.); (B.H.C.)
| | - Andrea J. Scallon
- Department of Global Health, University of Washington, Seattle, WA 98105, USA; (K.K.T.); (A.J.S.); (B.H.C.)
| | - Irene Mukui
- Drugs for Neglected Diseases Initiative (DNDI), Nairobi 21936, Kenya;
| | - Bhavna H. Chohan
- Department of Global Health, University of Washington, Seattle, WA 98105, USA; (K.K.T.); (A.J.S.); (B.H.C.)
- Kenya Medical Research Institute, Nairobi 00200, Kenya
| | | | | | | | - Bilaal Ahmed
- Department of Pediatrics, University of Colorado, Denver, CO 80045, USA
| | - Shukri A. Hassan
- Department of Medicine, University of Washington, Seattle, WA 98195, USA; (G.W.); (S.A.H.); (L.M.F.); (G.J.-S.); (R.C.P.)
| | - James Wagude
- Department of Health, Ministry of Health, Siaya 40600, Kenya
| | - Eunice Kinywa
- Department of Health, Ministry of Health, Kisumu 40100, Kenya
| | - Linda Otieno
- Family AIDS Care and Education Services, Kenya Medical Research Institute, Kisumu 40100, Kenya
| | - Leonard Kingwara
- National HIV Reference Laboratory, Kenya Ministry of Health, Nairobi 00202, Kenya;
| | - Boaz Oyaro
- Kenya Medical Research Institute-CDC, Kisumu 40100, Kenya;
| | - Lisa M. Frenkel
- Department of Medicine, University of Washington, Seattle, WA 98195, USA; (G.W.); (S.A.H.); (L.M.F.); (G.J.-S.); (R.C.P.)
- Department of Global Health, University of Washington, Seattle, WA 98105, USA; (K.K.T.); (A.J.S.); (B.H.C.)
- Departments of Pediatrics, University of Washington, Seattle, WA 98195, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98195, USA
| | - Grace John-Stewart
- Department of Medicine, University of Washington, Seattle, WA 98195, USA; (G.W.); (S.A.H.); (L.M.F.); (G.J.-S.); (R.C.P.)
- Department of Global Health, University of Washington, Seattle, WA 98105, USA; (K.K.T.); (A.J.S.); (B.H.C.)
- Departments of Pediatrics, University of Washington, Seattle, WA 98195, USA
| | - Rena C. Patel
- Department of Medicine, University of Washington, Seattle, WA 98195, USA; (G.W.); (S.A.H.); (L.M.F.); (G.J.-S.); (R.C.P.)
- Department of Global Health, University of Washington, Seattle, WA 98105, USA; (K.K.T.); (A.J.S.); (B.H.C.)
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Kumar A, Wahan SK, Virendra SA, Chawla PA. Recent Advances on the Role of Nitrogen‐Based Heterocyclic Scaffolds in Targeting HIV through Reverse Transcriptase Inhibition. ChemistrySelect 2022. [DOI: 10.1002/slct.202202637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Ankur Kumar
- Department of Pharmaceutical Chemistry ISF College of Pharmacy GT Road Ghal Kalan Moga 142001 India
| | - Simranpreet K. Wahan
- Department of Pharmaceutical Chemistry ISF College of Pharmacy GT Road Ghal Kalan Moga 142001 India
| | - Sharma Arvind Virendra
- Department of Pharmaceutical Chemistry ISF College of Pharmacy GT Road Ghal Kalan Moga 142001 India
| | - Pooja A. Chawla
- Department of Pharmaceutical Chemistry ISF College of Pharmacy GT Road Ghal Kalan Moga 142001 India
| |
Collapse
|
5
|
Weyland C, Mirani G, Gillespie SL, Paul ME. A Case of in utero Transmission of Drug-resistant HIV in the United States. Pediatr Infect Dis J 2022; 41:57-59. [PMID: 34609103 DOI: 10.1097/inf.0000000000003329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Thanks to the development of antiretroviral drugs and the implementation of routine perinatal prophylaxis, primarily containing zidovudine, modern-day rates of perinatal transmission of HIV are very low in developed countries. We present a case of perinatal transmission of HIV with extensive nucleoside reverse transcriptase inhibitor resistance as a reminder that perinatal transmission of resistance mutations can occur. This case calls for further investigation into the utility of using genotype to determine neonatal prophylaxis in the setting of maternal HIV drug resistance.
Collapse
Affiliation(s)
- Cassie Weyland
- From the Internal Medicine-Pediatrics, PGY-1, Baylor College of Medicine, Houston, Texas
| | - Gayatri Mirani
- Section of Immunology, Allergy, and Retrovirology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Susan L Gillespie
- Section of Immunology, Allergy, and Retrovirology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Mary E Paul
- Section of Immunology, Allergy, and Retrovirology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
6
|
Brice J, Sylla M, Desire N, Sayon S, Telly F, Bocar-Fofana D, Murphy R, Peytavin G, Diallo S, Nastouli E, Calvez V, Marcelin AG, Maiga AI, Lambert-Niclot S. Characterization of drug resistance and the defective HIV reservoir in virally suppressed vertically infected children in Mali. J Antimicrob Chemother 2021; 75:1272-1279. [PMID: 32073629 DOI: 10.1093/jac/dkaa002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/20/2019] [Accepted: 12/26/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In the perspective of ART-free HIV remission, vertically infected children treated with suppressive ART from early infancy represent an optimal population model to better understand the genetic complexity of the reservoir. OBJECTIVES To evaluate the proportion of defective viral population and the genotypic resistance patterns in cell-associated HIV DNA. METHODS In a cohort including 93 ART-treated vertically HIV-infected (VHIV) children in Mali with plasma HIV-1 RNA ≤50 copies/mL for at least 6 months, we studied total HIV DNA, percentage of defective genomes and resistance by reverse transcriptase and protease bulk sequencing from whole blood in dried blood spots. RESULTS Children had a median age of 9.9 years at the time of inclusion (IQR = 7.6-13.4) and 3.3 years (IQR = 2-7) at ART initiation; median ART duration was 5.5 years (IQR = 3.7-7.3). The median level of total HIV DNA was 470 copies/106 cells with one patient presenting undetectable HIV DNA (<66 copies/106 cells). We observed the presence of at least one stop codon in viruses from 34 patients (37%). The presence of stop codons was not correlated with the level of HIV DNA or duration of ART. We showed a high prevalence of HIV-1 resistance in DNA with 26% of children harbouring virus resistant to at least one NRTI and 40% to at least one NNRTI. CONCLUSIONS While these VHIV children were successfully treated for a long time, they showed high prevalence of resistance in HIV DNA and a moderate defective HIV reservoir.
Collapse
Affiliation(s)
- Josephine Brice
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Pitié Salpêtrière Hospital, Department of Virology, F-75013 Paris, France
| | - Mariam Sylla
- Department of Pediatrics, University Hospital Gabriel Toure, Bamako, Mali
| | - Nathalie Desire
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Pitié Salpêtrière Hospital, Department of Virology, F-75013 Paris, France
| | - Sophie Sayon
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Pitié Salpêtrière Hospital, Department of Virology, F-75013 Paris, France
| | - Fatoumata Telly
- Unité d'Epidémiologie Moléculaire de la Résistance du VIH aux ARV, SEREFO, FMOS, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Djeneba Bocar-Fofana
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Saint Antoine Hospital, Department of Virology, F-75012 Paris, France
| | - Robert Murphy
- Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, 645 N. Michigan Avenue, Suite 900, Chicago, IL 60611, USA
| | - Gilles Peytavin
- AP-HP, Department of Pharmacology, Bichat-Claude Bernard Hospital, F-75018 Paris, France
| | - Souleymane Diallo
- Unité d'Epidémiologie Moléculaire de la Résistance du VIH aux ARV, SEREFO, FMOS, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Eleni Nastouli
- Department of Population, Policy and Practice, University College London GOS Institute of Child Health, London, UK
| | - Vincent Calvez
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Pitié Salpêtrière Hospital, Department of Virology, F-75013 Paris, France
| | - Anne-Geneviève Marcelin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Pitié Salpêtrière Hospital, Department of Virology, F-75013 Paris, France
| | - Almoustapha Issiaka Maiga
- Unité d'Epidémiologie Moléculaire de la Résistance du VIH aux ARV, SEREFO, FMOS, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali.,Clinical and Microbiology Laboratory, University Hospital Gabriel Toure, Bamako, Mali
| | - Sidonie Lambert-Niclot
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Saint Antoine Hospital, Department of Virology, F-75012 Paris, France
| |
Collapse
|
7
|
High rate of loss to follow-up and virological non-suppression in HIV-infected children on antiretroviral therapy highlights the need to improve quality of care in South Africa. Epidemiol Infect 2021; 149:e88. [PMID: 33745490 PMCID: PMC8080219 DOI: 10.1017/s0950268821000637] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Provision of high-quality care and ensuring retention of children on antiretroviral therapy (ART) are essential to reduce human immunodeficiency virus (HIV)-associated morbidity and mortality. Virological non-suppression (≥1000 viral copies/ml) is an indication of suboptimal HIV care and support. This retrospective cohort study included ART-naïve children who initiated first-line ART between July 2015 and August 2017 in Johannesburg and rural Mopani district. Of 2739 children started on ART, 29.5% (807/2739) were lost to care at the point of analysis in August 2018. Among retained children, overall virological non-suppression was 30.2% (469/1554). Virological non-suppression was associated with higher loss to care 30.3% (229/755) compared with suppressed children (9.7%, 136/1399, P < 0.001). Receiving treatment in Mopani was associated with virological non-suppression in children under 5 years (adjusted odds ratio (aOR) 1.7 (95% confidence interval (CI) 1.1-2.4), 5-9 years (aOR 1.8 (1.1-3.0)) and 10-14 years (aOR 1.9 (1.2-2.8)). Virological non-suppression was associated with lower CD4 count in children 5-9 years (aOR 2.1 (1.1-4.1)) and 10-14 years (aOR 2.1 (1.2-3.8)). Additional factors included a shorter time on ART (<5 years aOR 1.8-3.7 (1.3-8.2)), and male gender (5-9 years, aOR1.5 (1.01-2.3)), and receiving cotrimoxazole prophylaxis (10-14 years aOR 2.0 (1.2-3.6)). In conclusion, virological non-suppression is a factor of subsequent programme loss in both regions, and factors affecting the quality of care need to be addressed to achieve the third UNAIDS 90 in paediatric HIV.
Collapse
|
8
|
Soeria‐Atmadja S, Amuge P, Nanzigu S, Bbuye D, Rubin J, Eriksen J, Kekitiinwa A, Obua C, Gustafsson LL, Navér L. Pretreatment HIV drug resistance predicts accumulation of new mutations in ART-naïve Ugandan children. Acta Paediatr 2020; 109:2706-2716. [PMID: 32304595 DOI: 10.1111/apa.15320] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 03/23/2020] [Accepted: 04/16/2020] [Indexed: 11/27/2022]
Abstract
AIM To assess the prevalence of pretreatment drug resistance (PDR) and its association with virologic outcomes after 24 weeks of antiretroviral therapy (ART), within an urban cohort of Ugandan children. METHODS Prospective observational study. Baseline and 24-week assessments of viral load (VL) and genotypic drug resistance to nucleoside reverse transcriptase inhibitors (NRTI) and non-nucleoside reverse transcriptase inhibitors (NNRTI) were performed. RESULTS Ninety-nine ART-naïve children (3-12 years) initiated efavirenz-based ART 2015-2016 and 18/90 (20%) had baseline NRTI/NNRTI associated drug resistance mutations (DRMs). By 24 weeks, 72/93 (77%) children had VL < 40 copies/mL and a total of 23 children had DRMs. Children with PDR accumulated new DRMs with a mean number (SD) of 1.4 (2.35) new mutations compared to 0.26 (0.98) in 67 children with wild-type virus (P = .003). High pretreatment VL and PDR (number of baseline DRMs) predicted viremia (P = .003; P = .023) as well as acquired drug resistance (P = .02; P = .04). CONCLUSION Pretreatment drug resistance to NNRTI/NRTI was common among ART-naïve Ugandan children and predicted viremia and new resistance mutations after only 24 weeks of efavirenz-based therapy. PDR may compromise long-term ART outcomes-especially when access to resistance testing and VL monitoring is poor. The long-term importance of PDR for non-NNRTI-based regimens needs further evaluation.
Collapse
Affiliation(s)
- Sandra Soeria‐Atmadja
- Department of Clinical Science, Intervention and Technology Division of Paediatrics Karolinska Institutet Stockholm Sweden
- Department of Paediatrics Karolinska University Hospital Stockholm Sweden
| | - Pauline Amuge
- Baylor College of Medicine Children’s Foundation‐Uganda Kampala Uganda
| | - Sarah Nanzigu
- Department of Clinical Pharmacology & Therapeutics Makerere University Kampala Uganda
| | - Dickson Bbuye
- Baylor College of Medicine Children’s Foundation‐Uganda Kampala Uganda
| | - Johanna Rubin
- Department of Clinical Science, Intervention and Technology Division of Paediatrics Karolinska Institutet Stockholm Sweden
| | - Jaran Eriksen
- Department of Laboratory Science Division of Clinical Pharmacology Karolinska Institutet Stockholm Sweden
- Department of Public Health Karolinska Institutet Stockholm Sweden
| | | | - Celestino Obua
- College of Health Sciences Mbarara University of Science and Technology Mbarara Uganda
| | - Lars L. Gustafsson
- Department of Laboratory Science Division of Clinical Pharmacology Karolinska Institutet Stockholm Sweden
| | - Lars Navér
- Department of Clinical Science, Intervention and Technology Division of Paediatrics Karolinska Institutet Stockholm Sweden
- Department of Paediatrics Karolinska University Hospital Stockholm Sweden
| |
Collapse
|
9
|
Bertagnolio S, Hermans L, Jordan MR, Avila-Rios S, Iwuji C, Derache A, Delaporte E, Wensing A, Aves T, Borhan ASM, Leenus A, Parkin N, Doherty M, Inzaule S, Mbuagbaw L. Clinical Impact of Pretreatment Human Immunodeficiency Virus Drug Resistance in People Initiating Nonnucleoside Reverse Transcriptase Inhibitor-Containing Antiretroviral Therapy: A Systematic Review and Meta-analysis. J Infect Dis 2020; 224:377-388. [PMID: 33202025 PMCID: PMC8328216 DOI: 10.1093/infdis/jiaa683] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/16/2020] [Indexed: 01/15/2023] Open
Abstract
Background Increased access to antiretroviral therapy (ART) has resulted in rising levels of pretreatment human immunodeficiency virus drug resistance (PDR). This is the first systematic review and meta-analysis to assess the impact of PDR on treatment outcomes among people initiating nonnucleoside reverse transcriptase inhibitor (NNRTI)–based ART, including the combination of efavirenz (EFV), tenofovir (TDF), and lamivudine or emtricitabine (XTC). Methods We systematically reviewed studies and conference proceedings comparing treatment outcomes in populations initiating NNRTI-based ART with and without PDR. We conducted subgroup analyses by regimen: (1) NNRTIs + 2 nucleoside reverse transcriptase inhibitors (NRTIs), (2) EFV + 2 NRTIs, or (3) EFV/TDF/XTC; by population (children vs adults); and by definition of resistance (PDR vs NNRTI PDR). Results Among 6197 studies screened, 32 were analyzed (31 441 patients). We found that individuals with PDR initiating NNRTIs across all the subgroups had increased risk of virological failure compared to those without PDR. Risk of acquisition of new resistance mutations and ART switch was also higher in people with PDR. Conclusions This review shows poorer treatment outcomes in the presence of PDR, supporting the World Health Organization’s recommendation to avoid using NNRTIs in countries where levels of PDR are high.
Collapse
Affiliation(s)
- Silvia Bertagnolio
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Lucas Hermans
- Virology, Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands.,Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Michael R Jordan
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA.,Division of Geographic Medicine and Infectious Disease, Tufts Medical Center, Boston, Massachusetts, USA.,Tufts Center for Integrated Management of Antimicrobial Resistance, Boston, Massachusetts, USA
| | - Santiago Avila-Rios
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Collins Iwuji
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Falmer, United Kingdom
| | - Anne Derache
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Eric Delaporte
- TransVIHMI, University of Montpellier, Institut de Recherche pour le Développement, Institut national de la santé et de la recherche médicale, Montpellier, France
| | - Annemarie Wensing
- Virology, Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands.,Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Theresa Aves
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - A S M Borhan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Alvin Leenus
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Neil Parkin
- Data First Consulting, Sebastopol, California, USA
| | - Meg Doherty
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Seth Inzaule
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
10
|
Camara-Cisse M, Djohan YF, Toni TD, Dechi JJR, N'Din JLP, Lohoues EE, Monde AA, Gogbe LO, Brou E, Fieni F, Mansour FA, Aby R, Kouakou K, Chenal H. Determination of reverse transcriptase inhibitor resistance mutations in HIV-1 infected children in Côte d'Ivoire. Genome 2020; 64:347-354. [PMID: 33170745 DOI: 10.1139/gen-2020-0112] [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: 11/22/2022]
Abstract
Treatment scale-up is leading to a progressive increase in HIV resistance to antiretrovirals, especially in children. To assess resistance to reverse transcriptase inhibitors (RTIs) in HIV-1 infected children in Côte d'Ivoire, genotypic resistance tests were performed and interpreted using the ANRS algorithm (www.hivfrenchresistance.org). Phylogenetic trees were created using BioEdit v7 and Mega7 software. The frequency of resistance to at least one RTI was 79%. It was 88% for nucleoside reverse transcriptase inhibitors (NRTIs), 71% for non-nucleoside reverse transcriptase inhibitors (NNRTIs), and 63% for both classes (NRTI + NNRTI). The frequency of resistance was 50% for the ZDV + 3TC + EFV combination, 42% for the ABC + 3TC + EFV combination, and 8% for the TDF + 3TC + EFV combination. Frequently encountered resistance mutations were for NRTIs: M184V (88%), TAMs (67%), T215F/I/V/Y (33%), and L74I/V (24%); for NNRTIs: K103N/S (74%), P225H (26%), and G190A/E/Q (24%). The synthesis of phylogenetic analyses showed the predominance of the viral subtype CRF02_AG (85%). These results show a high prevalence of resistance to RTIs in children infected with HIV-1. Hence the interest of a more accessible monitoring of viral load and genotypic resistance tests in HIV-1 infected children undergoing treatment in Côte d'Ivoire.
Collapse
Affiliation(s)
- Massara Camara-Cisse
- Laboratory of Biochemistry, UFR Medical Sciences, University Félix Houphouët-Boigny (UFHB), BP 582 Abidjan 22-Côte d'Ivoire
| | - Youzan Ferdinad Djohan
- Laboratory of Biochemistry, UFR Medical Sciences, University Félix Houphouët-Boigny (UFHB), BP 582 Abidjan 22-Côte d'Ivoire
| | - Thomas d'Aquin Toni
- Virology Laboratory, Integrated Centre for Bioclinical Research in Abidjan (CIRBA), BP 2071 Abidjan 18-Côte d'Ivoire
| | - Jean-Jacques Renaud Dechi
- Laboratory of Biochemistry, UFR Medical Sciences, University Félix Houphouët-Boigny (UFHB), BP 582 Abidjan 22-Côte d'Ivoire.,Virology Laboratory, Integrated Centre for Bioclinical Research in Abidjan (CIRBA), BP 2071 Abidjan 18-Côte d'Ivoire
| | - Jean-Louis Philippe N'Din
- Laboratory of Biochemistry, UFR Medical Sciences, University Félix Houphouët-Boigny (UFHB), BP 582 Abidjan 22-Côte d'Ivoire.,Virology Laboratory, Integrated Centre for Bioclinical Research in Abidjan (CIRBA), BP 2071 Abidjan 18-Côte d'Ivoire
| | - Esmel Essis Lohoues
- Laboratory of Biochemistry, UFR Medical Sciences, University Félix Houphouët-Boigny (UFHB), BP 582 Abidjan 22-Côte d'Ivoire
| | - Absalome Aké Monde
- Laboratory of Biochemistry, UFR Medical Sciences, University Félix Houphouët-Boigny (UFHB), BP 582 Abidjan 22-Côte d'Ivoire
| | - Leto Olivier Gogbe
- Virology Laboratory, Integrated Centre for Bioclinical Research in Abidjan (CIRBA), BP 2071 Abidjan 18-Côte d'Ivoire
| | - Emmanuel Brou
- Virology Laboratory, Integrated Centre for Bioclinical Research in Abidjan (CIRBA), BP 2071 Abidjan 18-Côte d'Ivoire
| | - Flore Fieni
- Virology Laboratory, Integrated Centre for Bioclinical Research in Abidjan (CIRBA), BP 2071 Abidjan 18-Côte d'Ivoire
| | - Franck Adéoti Mansour
- Laboratory of Biochemistry, UFR Medical Sciences, University Félix Houphouët-Boigny (UFHB), BP 582 Abidjan 22-Côte d'Ivoire
| | - Roland Aby
- Virology Laboratory, Integrated Centre for Bioclinical Research in Abidjan (CIRBA), BP 2071 Abidjan 18-Côte d'Ivoire
| | - Kouadio Kouakou
- Virology Laboratory, Integrated Centre for Bioclinical Research in Abidjan (CIRBA), BP 2071 Abidjan 18-Côte d'Ivoire
| | - Henri Chenal
- Virology Laboratory, Integrated Centre for Bioclinical Research in Abidjan (CIRBA), BP 2071 Abidjan 18-Côte d'Ivoire
| |
Collapse
|
11
|
Patel RC, Oyaro P, Odeny B, Mukui I, Thomas KK, Sharma M, Wagude J, Kinywa E, Oluoch F, Odhiambo F, Oyaro B, John-Stewart GC, Abuogi LL. Optimizing viral load suppression in Kenyan children on antiretroviral therapy (Opt4Kids). Contemp Clin Trials Commun 2020; 20:100673. [PMID: 33195874 PMCID: PMC7644580 DOI: 10.1016/j.conctc.2020.100673] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/26/2020] [Accepted: 10/22/2020] [Indexed: 12/16/2022] Open
Abstract
Background As many as 40% of the 1 million children living with HIV (CLHIV) receiving antiretroviral treatment (ART) in resource limited settings have not achieved viral suppression (VS). Kenya has a large burden of pediatric HIV with nearly 140,000 CLHIV. Feasible, scalable, and cost-effective approaches to ensure VS in CLHIV are urgently needed. The goal of this study is to determine the feasibility and impact of point-of-care (POC) viral load (VL) and targeted drug resistance mutation (DRM) testing to improve VS in children on ART in Kenya. Methods We are conducting a randomized controlled study to evaluate the use of POC VL and targeted DRM testing among 704 children aged 1-14 years on ART at health facilities in western Kenya. Children are randomized 1:1 to intervention (higher frequency POC VL and targeted DRM testing) vs. control (standard-of-care) arms and followed for 12 months. Our primary outcome is VS (VL < 1000 copies/mL) 12 months after enrollment by study arm. Secondary outcomes include time to VS and the impact of targeted DRM testing on VS. In addition, key informant interviews with patients and providers will generate an understanding of how the POC VL intervention functions. Finally, we will model the cost-effectiveness of POC VL combined with targeted DRM testing. Discussion This study will provide critical information on the impact of POC VL and DRM testing on VS among CLHIV on ART in a resource-limited setting and directly address the need to find approaches that maximize VS among children on ART. Trials registration NCT03820323.
Collapse
Affiliation(s)
- Rena C Patel
- Department of Medicine, University of Washington, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States
| | | | - Beryne Odeny
- Department of Global Health, University of Washington, Seattle, WA, United States
| | | | - Katherine K Thomas
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Monisha Sharma
- Department of Global Health, University of Washington, Seattle, WA, United States
| | | | | | | | - Francesca Odhiambo
- Family AIDS Care and Education Services, Kenya Medical Research Institute, Kisumu, Kenya
| | - Boaz Oyaro
- Kenya Medical Research Institute-CDC, Kisian, Kenya
| | - Grace C John-Stewart
- Department of Medicine, University of Washington, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States.,Departments of Pediatrics and Epidemiology, University of Washington, Seattle, WA, United States
| | - Lisa L Abuogi
- Department of Pediatrics, University of Colorado, Denver, CO, United States
| |
Collapse
|
12
|
Higa N, Pelz A, Birch D, Beck IA, Sils T, Samson P, Bwakura-Dangarembizi M, Bolton-Moore C, Capparelli E, Chadwick E, Frenkel LM. Association of Virologic Failure and Nonnucleoside Reverse Transcriptase Inhibitor Resistance Found in Antiretroviral-Naive Children Infected With Human Immunodeficiency Virus and Given Efavirenz-Based Treatment. J Pediatric Infect Dis Soc 2020; 9:261-264. [PMID: 31194860 PMCID: PMC7192398 DOI: 10.1093/jpids/piz038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 05/15/2019] [Indexed: 11/12/2022]
Abstract
Among 66 antiretroviral-naive children aged <3 years with human immunodeficiency virus (HIV) or coinfected with HIV and tuberculosis and initiating efavirenz-based antiretroviral therapy (ART), non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance was detected before ART in 5 (7.6%). Virologic failure occurred in 2 of these children; they were last tested at 16 and 24 weeks of ART. Pre-ART NNRTI resistance was not associated with virologic failure.
Collapse
Affiliation(s)
- Nikki Higa
- Seattle Children’s Research Institute, Washington
| | - Amy Pelz
- Seattle Children’s Research Institute, Washington
| | - Donald Birch
- Seattle Children’s Research Institute, Washington
| | | | - Tatiana Sils
- Seattle Children’s Research Institute, Washington
| | - Pearl Samson
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | - Carolyn Bolton-Moore
- Centre for Infectious Disease Research in Zambia, Lusaka
- University of Alabama at Birmingham, Alabama
| | | | - Ellen Chadwick
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lisa M Frenkel
- Seattle Children’s Research Institute, Washington
- University of Washington, Seattle
| |
Collapse
|
13
|
Shafer RW, Frenkel LM. The Clinical Implications of Pretreatment Drug Resistance-A Moving Target. Clin Infect Dis 2020; 69:215-217. [PMID: 30321316 DOI: 10.1093/cid/ciy895] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 10/10/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Robert W Shafer
- Division of Infectious Diseases, Department of Medicine, Stanford University, California
| | - Lisa M Frenkel
- Division of Infectious Diseases, Department of Pediatrics, University of Washington, Seattle
| |
Collapse
|
14
|
Keita A, Sereme Y, Pillet S, Coulibaly S, Diallo F, Pozzetto B, Thiero TA, Bourlet T. Impact of HIV-1 primary drug resistance on the efficacy of a first-line antiretroviral regimen in the blood of newly diagnosed individuals in Bamako, Mali. J Antimicrob Chemother 2020; 74:165-171. [PMID: 30285106 DOI: 10.1093/jac/dky382] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/24/2018] [Indexed: 12/30/2022] Open
Abstract
Background To achieve the 90-90-90 targets assigned by UNAIDS, it is crucial to monitor ART in HIV-1-infected patients, especially in resource-limited countries. Objectives To evaluate the immunovirological response after 12 months of ART in newly HIV-1-diagnosed people in Bamako, Mali; to determine primary and acquired resistance rates to antiretroviral drugs; and to evaluate the impact of primary resistance on the efficacy of ART. Patients and methods One hundred and nineteen HIV-1-infected people (88.2% women; median age 34 years) were enrolled between January and June 2014. HIV-1 RNA loads (Abbott RealTime HIV-1 assay) were tested in the blood before and at months 3, 6 and 12 after initiation of ART. Primary and acquired resistances to ART were evaluated by the Viroseq™ HIV-1 genotyping assay. Results During the study, 8.4% of people died and 37% were lost to follow-up. After 1 year of ART, an undetectable HIV-1 RNA viral load was found in 87.7% of cases. The overall rate of primary drug resistance mutations was 17.5% (3.2%, 15.9% and 0% for NRTIs, NNRTIs and PIs, respectively). These mutations were not associated with either higher mortality rates or larger numbers of virological failures. The acquired resistance rate was estimated at 3.1%. Conclusions Our study showed a high primary resistance level and a huge proportion of people non-adherent to the treatment programme. Reassuringly, almost 90% virological success and a low level of acquired mutations were observed in adherent people at month 12. Reinforced education, regular virological monitoring and early HIV-1 diagnosis may help to improve retention in the care system.
Collapse
Affiliation(s)
- Abdelaye Keita
- Institut National de Recherche en Santé Publique (INRSP), Bamako, Mali.,Groupe Immunité des Muqueuses et Agents Pathogènes GIMAP EA3064, University of Saint-Etienne, University of Lyon, Saint-Etienne, France
| | - Youssouf Sereme
- Groupe Immunité des Muqueuses et Agents Pathogènes GIMAP EA3064, University of Saint-Etienne, University of Lyon, Saint-Etienne, France
| | - Sylvie Pillet
- Groupe Immunité des Muqueuses et Agents Pathogènes GIMAP EA3064, University of Saint-Etienne, University of Lyon, Saint-Etienne, France.,Laboratoire des Agents Infectieux et d'Hygiène, University Hospital of Saint-Etienne, Saint Etienne, France
| | | | - Fodié Diallo
- Centre d'écoute de soins et d'accompagnement (CESAC), Bamako, Mali
| | - Bruno Pozzetto
- Groupe Immunité des Muqueuses et Agents Pathogènes GIMAP EA3064, University of Saint-Etienne, University of Lyon, Saint-Etienne, France.,Laboratoire des Agents Infectieux et d'Hygiène, University Hospital of Saint-Etienne, Saint Etienne, France
| | - Tenin Aoua Thiero
- Institut National de Recherche en Santé Publique (INRSP), Bamako, Mali
| | - Thomas Bourlet
- Groupe Immunité des Muqueuses et Agents Pathogènes GIMAP EA3064, University of Saint-Etienne, University of Lyon, Saint-Etienne, France.,Laboratoire des Agents Infectieux et d'Hygiène, University Hospital of Saint-Etienne, Saint Etienne, France
| |
Collapse
|
15
|
Fofana DB, d'Almeida M, Lambert-Niclot S, Peytavin G, Girard PM, Lafia B, Zohoun-Guidigbi L, Keke RK, Soulie C, Marcelin AG, Morand-Joubert L. Resistance profile and treatment outcomes in HIV-infected children at virological failure in Benin, West Africa. J Antimicrob Chemother 2019; 73:3143-3147. [PMID: 30060186 DOI: 10.1093/jac/dky300] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 06/26/2018] [Indexed: 11/14/2022] Open
Abstract
Background In Africa a high percentage of HIV-infected children continue to experience HIV treatment failure despite enormous progress. In Benin (West Africa), there are currently no data on HIV drug resistance at failure in paediatric populations. Objectives To assess the frequency and patterns of HIV drug resistance among children with virological ART failures. Methods Dried blood spots from 62 HIV-infected children with virological failure were collected at the paediatric clinic of the National Hospital Center in Cotonou for genotyping and plasma drug concentration determination. Results Characteristics of the population show a median age of 10 years (IQR 6-13) and a median duration on ART of 5 years (IQR 3-7). Viruses from 53 children were successfully amplified. Of these, 76% of patients were on an NNRTI-based regimen and 24% on a boosted PI-based regimen. NRTI, NNRTI and dual-class resistance was present in 71%, 84% and 65% of cases, respectively. Only 4% of the children had major resistance mutations to PIs and none had major resistance mutations to integrase inhibitors. Among the participants, 25% had undetectable antiretroviral concentrations. Conclusions Our results showed that the development of drug resistance could be one of the main consequences of high and continuous viral replication in HIV-infected children in Benin. Thus, inadequate attention to monitoring lifelong ART in children may prevent achievement of the goal of the United Nations Program on HIV and AIDS (UNAIDS) of 90% viral suppression among patients receiving ART.
Collapse
Affiliation(s)
- D B Fofana
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Saint Antoine, Laboratoire de virologie, Paris, France
| | - M d'Almeida
- Département Mère Enfant, Faculté Des Sciences De La Santé, Université Abomey - Calavi, CNHU - HKM, Cotonou, Bénin
| | - S Lambert-Niclot
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Saint Antoine, Laboratoire de virologie, Paris, France
| | - G Peytavin
- Laboratoire de Pharmaco-Toxicologie, Hôpital Bichat-Claude Bernard, Paris, France
| | - P M Girard
- Department of Infectious and Tropical Diseases, Saint-Antoine Hospital AP-HP, Paris, France
| | - B Lafia
- Reference Laboratory of the National Program Against Aids CNHU - HKM, Cotonou, Bénin
| | - L Zohoun-Guidigbi
- Département Mère Enfant, Faculté Des Sciences De La Santé, Université Abomey - Calavi, CNHU - HKM, Cotonou, Bénin
| | - R K Keke
- Reference Laboratory of the National Center for the Treatment of HIV, Cotonou, Benin
| | - C Soulie
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié Salpêtrière, Laboratoire de virologie, Paris, France
| | - A G Marcelin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié Salpêtrière, Laboratoire de virologie, Paris, France
| | - L Morand-Joubert
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Saint Antoine, Laboratoire de virologie, Paris, France
| |
Collapse
|
16
|
Taffa N, Roscoe C, Sawadogo S, De Klerk M, Baughman AL, Wolkon A, Mutenda N, DeVos J, Zheng DP, Wagar N, Prybylski D, Yang C, Hamunime N, Agolory S, Raizes E. Pretreatment HIV drug resistance among adults initiating ART in Namibia. J Antimicrob Chemother 2019; 73:3137-3142. [PMID: 30137412 DOI: 10.1093/jac/dky278] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/19/2018] [Indexed: 11/12/2022] Open
Abstract
Background Continued use of standardized, first-line ART containing NNRTIs and NRTIs may contribute to ongoing emergence of HIV drug resistance (HIVDR) in Namibia. Methods A nationally representative cross-sectional survey was conducted during 2015-16 to estimate the prevalence of significant pretreatment HIV drug resistance (PDR) and viral load (VL) suppression rates 6-12 months after initiating standardized first-line ART. Consenting adult patients (≥18 years) initiating ART were interviewed about prior antiretroviral drug (ARV) exposure and underwent resistance testing using dried blood spot samples. PDR was defined as mutations causing low-, intermediate- and high-level resistance to ARVs according to the 2014 WHO Surveillance of HIV Drug Resistance in Adults Initiating ART. The prevalence of PDR was described by patient characteristics, ARV exposure and VL results. Results were weighted to be nationally representative. Results Successful genotyping was performed for 381 specimens; 144 (36.6%) specimens demonstrated HIVDR, of which 54 (12.7%) demonstrated PDR. Resistance to NNRTIs was most prevalent (11.9%). PDR was higher in patients with previous ARV exposure compared with no exposure (30.5% versus 9.6%) (prevalence ratio = 3.17; P < 0.01). Conclusions This survey demonstrated overall PDR at >10% among adults initiating ART in Namibia. Patients with prior ARV exposure had higher rates of PDR. Introducing a non-NNRTI-based regimen for first-line ART should be considered to maximize benefit of ART and minimize the emergence of HIVDR.
Collapse
Affiliation(s)
- Negussie Taffa
- Centers for Disease Control and Prevention (CDC), Windhoek, Namibia
| | - Clay Roscoe
- Centers for Disease Control and Prevention (CDC), Windhoek, Namibia
| | | | - Michael De Klerk
- Centers for Disease Control and Prevention (CDC), Windhoek, Namibia
| | | | - Adam Wolkon
- Centers for Disease Control and Prevention (CDC), Windhoek, Namibia
| | - Nicholus Mutenda
- Directorate of Special Programs (DSP) for HIV, TB and Malaria, Ministry of Health and Social Services (MoHSS), Windhoek, Namibia
| | - Josh DeVos
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Du-Ping Zheng
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Nick Wagar
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | | | - Chunfu Yang
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Ndapewa Hamunime
- Directorate of Special Programs (DSP) for HIV, TB and Malaria, Ministry of Health and Social Services (MoHSS), Windhoek, Namibia
| | - Simon Agolory
- Centers for Disease Control and Prevention (CDC), Windhoek, Namibia
| | - Elliot Raizes
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| |
Collapse
|
17
|
Second-line antiretroviral therapy failure and characterization of HIV-1 drug resistance patterns in children in Mali. Arch Pediatr 2019; 26:254-258. [PMID: 31307909 DOI: 10.1016/j.arcped.2019.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/06/2019] [Accepted: 06/12/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION In recent years, children born to HIV-infected mothers have been receiving antiretroviral treatment (ART) with limited or no virologic monitoring, which increases the likelihood of development and accumulation of drug resistance mutations, which itself may limit the effectiveness of future ART. The objective of this study was to evaluate the prevalence of resistance mutations in children infected with HIV-1 experiencing virological failure to second-line ART in the Pediatric Department of Gabriel Touré Hospital in Mali. METHODS Children aged from 5 to 18 infected with HIV-1 on second-line antiretroviral therapy and whose viral load was greater than 1000 copies/mL after observance reinforcement were enrolled. The protease and reverse transcriptase genes were sequenced with ViroSeq®. The results were interpreted according to the last version of the Stanford algorithm in 2018. The study was approved by the Ethics Committee of the Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technologies of Bamako (Mali). RESULTS Of 216 children, 33 (15.3%) who had a viral load (VL)>1000 copies/mL in second line were recruited and included in the study. The median plasma viral load was 77,000 copies/mL [IQR (28,000-290,000)] and the median CD4 cell count was 310 cells/mm3 [IQR (152-412)]. The median age was 12 years; 48.5% of patients were treated with a combination of stavudine/lamivudine/nevirapine (Triomune®) for first-line treatment and 60.6% with abacavir/lamivudine/lopinavir/ritonavir for the second-line ART. The median treatment duration was 8.5 years [range, 3-13]. Of the 33 children whose treatment failed, the predominant HIV-1 subtype was CRF02_AG (66.7%). The prevalence of resistance to ART classes was 60.61% (20/33) to nucleoside reverse transcriptase inhibitors (NRTIs), 54.51% (18/33) to nonnucleoside reverse transcriptase inhibitors (NNRTIs), and 51.52% (17/33) to protease inhibitors (PIs). Of the patients studied, 90.9% were exposed to lopinavir/ritonavir (LPV/r) but only 15.2% (5/33) developed resistance to LPV/r. CONCLUSIONS This study demonstrated that LPV/r remains active in most patients after second-line ART failure. In children whose second-line ART fails, particular attention should be paid to their ART and adherence history when considering the next treatment option.
Collapse
|
18
|
Chandrasekaran P, Shet A, Srinivasan R, Sanjeeva GN, Subramanyan S, Sunderesan S, Ramesh K, Gopalan B, Suresh E, Poornagangadevi N, Hanna LE, Chandrasekar C, Wanke C, Swaminathan S. Long-term virological outcome in children receiving first-line antiretroviral therapy. AIDS Res Ther 2018; 15:23. [PMID: 30477526 PMCID: PMC6260781 DOI: 10.1186/s12981-018-0208-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 11/08/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Studies relating to long-term virological outcomes among children on first-line antiretroviral therapy (ART) from low and middle-income countries are limited. METHODS Perinatally HIV infected, ART-naive children, between 2 and 12 years of age, initiating NNRTI-based ART during 2010-2015, with at least 12 months of follow-up, were included in the analysis. CD4 cell counts and plasma HIV-1 RNA were measured every 24 weeks post-ART initiation. Immunologic failure was defined as a decrease in the CD4 count to pre-therapy levels or below and virologic failure as HIV-RNA of > 1000 copies/ml at 48 weeks after ART initiation. Genotypic resistance testing was performed for children with virologic failure. Logistic regression analysis was done to identify predictors of virologic failure. RESULTS Three hundred and ninety-three ART-naïve children living with HIV [mean (SD) age: 7.6 (3) years; mean (SD) CD4%: 16% (8); median (IQR) HIV-RNA: 5.1 (3.5-5.7) log10 copies/ml] were enrolled into the study. At 48 weeks, significant improvement occurred in weight-for-age and height-for-age z-scores from baseline (all p < 0.001). The immunologic response was good; almost 90% of children showing an increase in their absolute CD4+ T cell count to more than 350 cells/mm3. Immunological failure was noted among 11% (28/261) and virologic failure in 29% (94/328) of children. Of the 94 children with virologic failure at 12 months, 36 children showed immunologic failure while the rest had good immunologic improvement. There was no demonstrable correlation between virologic and immunologic failure. 62% had reported > 90% adherence to ART. At the time of virologic failure, multiple NNRTI-associated mutations were observed: 80%-K103N and Y181C being the major NNRTI mutations-observed. Sensitivity (95% CI) of immunologic failure to detect virologic failure was 7% (2-12), specificity 97% (92.4-98.9), PPV 44% (13.7-78.8) and NPV was 72% (65-77.9). There were no statistically significant predictors to detect children who will develop virologic failure on treatment. CONCLUSIONS Considerable immunological improvement is seen in children with ART initiation, but may not be an effective tool to monitor treatment response in the long-term. There is a lack of correlation between immunologic and virologic response while on ART, which may lead to a delay in identifying treatment failures. Periodic viral load monitoring is, therefore, a priority.
Collapse
Affiliation(s)
- Padmapriyadarsini Chandrasekaran
- Department of Clinic Research, ICMR-National Institute for Research in Tuberculosis, No. 1, Mayor Sathyamoorthy Road, Chetpet, Chennai, Tamil Nadu 600031 India
| | - Anita Shet
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- St Johns Research Institute, Bangalore, India
| | - Ramalingam Srinivasan
- Department of Clinic Research, ICMR-National Institute for Research in Tuberculosis, No. 1, Mayor Sathyamoorthy Road, Chetpet, Chennai, Tamil Nadu 600031 India
| | - G. N. Sanjeeva
- Indira Gandhi Institute of Child Health, Bangalore, India
| | - Sudha Subramanyan
- Department of Clinic Research, ICMR-National Institute for Research in Tuberculosis, No. 1, Mayor Sathyamoorthy Road, Chetpet, Chennai, Tamil Nadu 600031 India
| | | | - Karunaianantham Ramesh
- Department of Clinic Research, ICMR-National Institute for Research in Tuberculosis, No. 1, Mayor Sathyamoorthy Road, Chetpet, Chennai, Tamil Nadu 600031 India
| | | | - Elumalai Suresh
- Institute of Child Health and Government Hospital for Children, Chennai, India
| | - Navaneethan Poornagangadevi
- Department of Clinic Research, ICMR-National Institute for Research in Tuberculosis, No. 1, Mayor Sathyamoorthy Road, Chetpet, Chennai, Tamil Nadu 600031 India
| | - Luke E. Hanna
- Department of Clinic Research, ICMR-National Institute for Research in Tuberculosis, No. 1, Mayor Sathyamoorthy Road, Chetpet, Chennai, Tamil Nadu 600031 India
| | | | | | - Soumya Swaminathan
- Indian Council of Medical Research, New Delhi, India
- Present Address: World Health Organization, Geneva, Switzerland
| |
Collapse
|
19
|
Kadima J, Patterson E, Mburu M, Blat C, Nyanduko M, Bukusi EA, Cohen C, Oyaro P, Abuogi L. Adoption of routine virologic testing and predictors of virologic failure among HIV-infected children on antiretroviral treatment in western Kenya. PLoS One 2018; 13:e0200242. [PMID: 30412576 PMCID: PMC6226151 DOI: 10.1371/journal.pone.0200242] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 06/23/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Access to routine virologic monitoring, critical to ensuring treatment success, remains limited in low- and middle-income countries. We report on implementation of routine viral load (VL) monitoring and risk factors for virologic failure among HIV-infected children on antiretroviral treatment (ART) in Western Kenya. METHODS Routine VL testing was introduced in western Kenya in November 2013. We performed a case-control study among 1190 HIV-infected children ≤15 years on ART who underwent routine VL testing June 2014-May 2015. A random sample of 98 cases (virologic failure define as VL >1000 cps/mL) and 201 controls (VL <1000 cps/mL) from five facilities in three high HIV prevalence counties in Kenya were followed for a minimum of 12 months. Data from patient charts were analyzed using logistic regression to determine factors associated with failure to attain virologic suppression at initial routine and subsequent VL testing among cases. RESULTS Overall, 1190 (94%) children with a median age of 8 years underwent routine VL testing of whom (37%) had virological failure. Among the 299 cases and controls, WHO stage, baseline CD4 count and time since ART initiation were not associated with virologic failure during the follow-up period. In multivariable analysis, unsuppressed children at initial test were more likely to be male (adjusted Odds Ratio (aOR) 2.1, 95% Confidence Interval (CI) 2.1-3.6) and have had an ART regimen change (aOR 2.0, CI 1.0-3.7) than controls. Of the two-thirds of children 201/299 who had a subsequent VL performed, VL suppression was greater among those suppressed at initial test 126/135 (93.3%) compared to children with virologic failure 15/66 (22.7%, p<0.0001). Among those failing at first test who achieved viral suppression in follow up, 12/15 (80%) were on a protease inhibitor (PI)-based regimen. In the multivariable analysis of children with subsequent VL testing, children on PI-based 2nd line regimens were 10-fold more likely to achieve viral suppression than children on first-line NNRTI-based ART (adjusted Odds Ratio [aOR] 0.1; 95%CI 0.0-0.4). CONCLUSION Coverage of initial routine viral load testing among children on ART in western Kenya is high. However, subsequent testing and virologic suppression are low in children with virologic failure on initial routine viral load test. There is an urgent need to improve management and viral load monitoring of children living with HIV experiencing treatment failure to ensure improved long-term outcomes.
Collapse
Affiliation(s)
- Julie Kadima
- Family AIDS Care and Education Services (FACES), Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Elizabeth Patterson
- University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Margaret Mburu
- Family AIDS Care and Education Services (FACES), Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Cinthia Blat
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
| | | | - Elizabeth Anne Bukusi
- Family AIDS Care and Education Services (FACES), Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Craig Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Patrick Oyaro
- Family AIDS Care and Education Services (FACES), Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Lisa Abuogi
- Department of Pediatrics, University of Colorado Denver, Aurora, Colorado, United States of America
| |
Collapse
|
20
|
Abstract
PURPOSE OF REVIEW The purpose of this review is to describe recent clinical trial, laboratory and observational findings that highlight both the progress that can be achieved in elimination of new pediatric infections in international clinical trial settings among HIV-infected breastfeeding women while also describing recent safety concerns related to currently used antiretroviral regimens. The article will also address the ongoing adherence challenges for HIV-infected mothers in taking their antiretroviral drugs. This information is timely and relevant as new regimens are being considered for both prevention of mother-to-child transmission (PMTCT) of HIV and HIV treatment options worldwide. RECENT FINDINGS The main themes described in this article include both efficacy of different antiretroviral therapy (ART) regimens currently being rolled out internationally for PMTCT as well as safety findings from recent research including a large multisite international trial, PROMISE. SUMMARY The findings from the IMPAACT PROMISE trial as well as other recent trial and observational findings suggest that while progress has been steady in reducing PMTCT worldwide, the goal of virtual elimination of pediatric HIV worldwide will require careful attention to optimizing safety of new regimens which are less dependent on maternal daily ART adherence and safer in preventing certain toxicities.
Collapse
Affiliation(s)
- Mary G Fowler
- Department of Pathology, Johns Hopkins U. School of Medicine, Baltimore, Maryland
| | - Patricia Flynn
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jim Aizire
- Department of Epidemiology, Johns Hopkins U. Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
21
|
Br Karo M, Tambaip T, Hatta M, Dwiyanti R, Natzir R, Nasrum Mas M, Asadul Isl A, Djawad K. Immunomodulatory Effect of Orally Red Fruit (Pandanus conoideus) Extract on the Expression of CC Chemokine Receptor 5 mRNA in HIV Patients with Antiretroviral Therapy. RESEARCH JOURNAL OF IMMUNOLOGY 2018; 11:15-21. [DOI: 10.3923/rji.2018.15.21] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
|
22
|
Bertagnolio S, Beanland RL, Jordan MR, Doherty M, Hirnschall G. The World Health Organization's Response to Emerging Human Immunodeficiency Virus Drug Resistance and a Call for Global Action. J Infect Dis 2017; 216:S801-S804. [PMID: 29040686 PMCID: PMC5853942 DOI: 10.1093/infdis/jix402] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The global community, including the World Health Organization (WHO), has committed to ending the AIDS epidemic and to ensuring that 90% of people living with human immunodeficiency virus (HIV) are diagnosed, 90% start treatment, and 90% achieve and maintain virological suppression. The emergence of HIV drug resistance (HIVDR) as antiretroviral treatment programs expand could preclude the 90-90-90 targets adopted by the United Nations General Assembly at the High-Level Meeting on Ending AIDS from being achieved. The Global Action Plan on HIVDR is a call for collective action grounded on normative guidance providing a standardized and robust approach to monitoring, preventing, and responding to HIVDR over the next 5 years (2017-2021). WHO is committed to supporting country, global, regional, and national partners to implement and monitor the progress of the Global Action Plan. This article outlines the key components of WHO's strategy to tackle HIVDR and the role the organization takes in leading the global response to HIVDR.
Collapse
|