HIV-1 drug resistance in adults and adolescents on protease inhibitor-based antiretroviral therapy in KwaZulu-Natal Province, South Africa
Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved..
OBJECTIVES: In low-middle-income countries, increasing levels of HIV drug resistance (HIVDR) on second-line protease inhibitor (PI)-based regimens are a cause for concern given the limited drug options for third-line antiretroviral therapy (ART). We conducted a retrospective analysis of routine HIV-1 genotyping laboratory data from KwaZulu-Natal, South Africa, to describe the frequency and patterns of HIVDR mutations and their consequent impact on standardised third-line regimens.
METHODS: This was a cross-sectional analysis of all HIV-1 genotypic resistance tests conducted by the National Health Laboratory Service in KwaZulu-Natal (January 2015 to December 2016) for adults and adolescents (age ≥10 years) on second-line PI-based ART with virological failure. We assigned a third-line regimen to each record based on a national treatment algorithm and calculated the genotypic susceptibility score (GSS) for that regimen.
RESULTS: Of 348 samples analysed, 287 (82.5%) had at least one drug resistance mutation (DRM) and 114 (32.8%) had at least one major PI DRM. Major PI resistance was associated with longer duration on second-line ART (aOR per 6-months = 1.11, 95% CI 1.04-1.19) and older age (aOR = 1.03, 95% CI 1.01-1.05). Of 112 patients requiring third-line ART, 12 (10.7%) had a GSS of <2 for the algorithm-assigned third-line regimen.
CONCLUSION: One-third of people failing second-line ART had significant PI DRMs. A subgroup of these individuals had extensive HIVDR, where the predicted activity of third-line ART was suboptimal, highlighting the need for continuous evaluation of outcomes on third-line regimens and close monitoring for emergent HIV-1 integrase inhibitor resistance.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:29 |
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| Enthalten in: |
Journal of global antimicrobial resistance - 29(2022) vom: 16. Juni, Seite 468-475 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Chimukangara, Benjamin [VerfasserIn] |
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| Links: |
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| Themen: |
Adults and adolescents |
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| Anmerkungen: |
Date Completed 21.06.2022 Date Revised 03.10.2022 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.jgar.2021.10.023 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM333230841 |
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| 100 | 1 | |a Chimukangara, Benjamin |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a HIV-1 drug resistance in adults and adolescents on protease inhibitor-based antiretroviral therapy in KwaZulu-Natal Province, South Africa |
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| 500 | |a Date Completed 21.06.2022 | ||
| 500 | |a Date Revised 03.10.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved. | ||
| 520 | |a OBJECTIVES: In low-middle-income countries, increasing levels of HIV drug resistance (HIVDR) on second-line protease inhibitor (PI)-based regimens are a cause for concern given the limited drug options for third-line antiretroviral therapy (ART). We conducted a retrospective analysis of routine HIV-1 genotyping laboratory data from KwaZulu-Natal, South Africa, to describe the frequency and patterns of HIVDR mutations and their consequent impact on standardised third-line regimens | ||
| 520 | |a METHODS: This was a cross-sectional analysis of all HIV-1 genotypic resistance tests conducted by the National Health Laboratory Service in KwaZulu-Natal (January 2015 to December 2016) for adults and adolescents (age ≥10 years) on second-line PI-based ART with virological failure. We assigned a third-line regimen to each record based on a national treatment algorithm and calculated the genotypic susceptibility score (GSS) for that regimen | ||
| 520 | |a RESULTS: Of 348 samples analysed, 287 (82.5%) had at least one drug resistance mutation (DRM) and 114 (32.8%) had at least one major PI DRM. Major PI resistance was associated with longer duration on second-line ART (aOR per 6-months = 1.11, 95% CI 1.04-1.19) and older age (aOR = 1.03, 95% CI 1.01-1.05). Of 112 patients requiring third-line ART, 12 (10.7%) had a GSS of <2 for the algorithm-assigned third-line regimen | ||
| 520 | |a CONCLUSION: One-third of people failing second-line ART had significant PI DRMs. A subgroup of these individuals had extensive HIVDR, where the predicted activity of third-line ART was suboptimal, highlighting the need for continuous evaluation of outcomes on third-line regimens and close monitoring for emergent HIV-1 integrase inhibitor resistance | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Adults and adolescents | |
| 650 | 4 | |a Antiretroviral therapy | |
| 650 | 4 | |a Drug resistance | |
| 650 | 4 | |a HIV-1 | |
| 650 | 4 | |a Protease inhibitor | |
| 650 | 4 | |a Third-line ART | |
| 650 | 7 | |a Anti-HIV Agents |2 NLM | |
| 650 | 7 | |a Protease Inhibitors |2 NLM | |
| 700 | 1 | |a Lessells, Richard J |e verfasserin |4 aut | |
| 700 | 1 | |a Sartorius, Benn |e verfasserin |4 aut | |
| 700 | 1 | |a Gounder, Lilishia |e verfasserin |4 aut | |
| 700 | 1 | |a Manyana, Sontaga |e verfasserin |4 aut | |
| 700 | 1 | |a Pillay, Melendhran |e verfasserin |4 aut | |
| 700 | 1 | |a Singh, Lavanya |e verfasserin |4 aut | |
| 700 | 1 | |a Giandhari, Jennifer |e verfasserin |4 aut | |
| 700 | 1 | |a Govender, Kerusha |e verfasserin |4 aut | |
| 700 | 1 | |a Samuel, Reshmi |e verfasserin |4 aut | |
| 700 | 1 | |a Msomi, Nokukhanya |e verfasserin |4 aut | |
| 700 | 1 | |a Naidoo, Kogieleum |e verfasserin |4 aut | |
| 700 | 1 | |a de Oliveira, Tulio |e verfasserin |4 aut | |
| 700 | 1 | |a Moodley, Pravi |e verfasserin |4 aut | |
| 700 | 1 | |a Parboosing, Raveen |e verfasserin |4 aut | |
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