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Accumulation of HIV-1 drug resistance after continued virological failure on first-line ART in adults and children in sub-Saharan Africa
Limited availability of viral load (VL) monitoring in HIV treatment programmes in sub-Saharan Africa can delay switching to second-line ART, leading to the accumulation of drug resistance mutations (DRMs). The objective of this study was to evaluate the accumulation of resistance to reverse transcri...
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Published in: | Journal of antimicrobial chemotherapy 2016-10, Vol.71 (10), p.2918-2927 |
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creator | Boender, T Sonia Kityo, Cissy M Boerma, Ragna S Hamers, Raph L Ondoa, Pascale Wellington, Maureen Siwale, Margaret Nankya, Immaculate Kaudha, Elizabeth Akanmu, Alani Sulaimon Botes, Mariette E Steegen, Kim Calis, Job C J Rinke de Wit, Tobias F Sigaloff, Kim C E |
description | Limited availability of viral load (VL) monitoring in HIV treatment programmes in sub-Saharan Africa can delay switching to second-line ART, leading to the accumulation of drug resistance mutations (DRMs). The objective of this study was to evaluate the accumulation of resistance to reverse transcriptase inhibitors after continued virological failure on first-line ART, among adults and children in sub-Saharan Africa.
HIV-1-positive adults and children on an NNRTI-based first-line ART were included. Retrospective VL and, if VL ≥1000 copies/mL, pol genotypic testing was performed. Among participants with continued virological failure (≥2 VL ≥1000 copies/mL), drug resistance was evaluated.
At first virological failure, DRM(s) were detected in 87% of participants: K103N (38.7%), G190A (21.8%), Y181C (20.2%), V106M (8.4%), K101E (8.4%), any E138 (7.6%) and V108I (7.6%) associated with NNRTIs, and M184V (69.7%), any thymidine analogue mutation (9.2%), K65R (5.9%) and K70R (5.0%) associated with NRTIs. New DRMs accumulated with an average rate of 1.45 (SD 2.07) DRM per year; 0.62 (SD 1.11) NNRTI DRMs and 0.84 (SD 1.38) NRTI DRMs per year, respectively. The predicted susceptibility declined significantly after continued virological failure for all reverse transcriptase inhibitors (all P |
doi_str_mv | 10.1093/jac/dkw218 |
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HIV-1-positive adults and children on an NNRTI-based first-line ART were included. Retrospective VL and, if VL ≥1000 copies/mL, pol genotypic testing was performed. Among participants with continued virological failure (≥2 VL ≥1000 copies/mL), drug resistance was evaluated.
At first virological failure, DRM(s) were detected in 87% of participants: K103N (38.7%), G190A (21.8%), Y181C (20.2%), V106M (8.4%), K101E (8.4%), any E138 (7.6%) and V108I (7.6%) associated with NNRTIs, and M184V (69.7%), any thymidine analogue mutation (9.2%), K65R (5.9%) and K70R (5.0%) associated with NRTIs. New DRMs accumulated with an average rate of 1.45 (SD 2.07) DRM per year; 0.62 (SD 1.11) NNRTI DRMs and 0.84 (SD 1.38) NRTI DRMs per year, respectively. The predicted susceptibility declined significantly after continued virological failure for all reverse transcriptase inhibitors (all P < 0.001). Acquired drug resistance patterns were similar in adults and children.
Patterns of drug resistance after virological failure on first-line ART are similar in adults and children in sub-Saharan Africa. Improved VL monitoring to prevent accumulation of mutations, and new drug classes to construct fully active regimens, are required.</description><identifier>ISSN: 0305-7453</identifier><identifier>EISSN: 1460-2091</identifier><identifier>DOI: 10.1093/jac/dkw218</identifier><identifier>PMID: 27342546</identifier><language>eng</language><publisher>England</publisher><subject>Adolescent ; Adult ; Africa South of the Sahara - epidemiology ; Anti-HIV Agents - administration & dosage ; Anti-HIV Agents - adverse effects ; Anti-HIV Agents - therapeutic use ; Antiretroviral Therapy, Highly Active - adverse effects ; Child ; Child, Preschool ; Drug Resistance, Viral - genetics ; Female ; HIV Infections - drug therapy ; HIV Infections - epidemiology ; HIV Infections - virology ; HIV-1 - drug effects ; HIV-1 - genetics ; HIV-1 - isolation & purification ; Humans ; Male ; Mutation ; Retrospective Studies ; Reverse Transcriptase Inhibitors - administration & dosage ; Reverse Transcriptase Inhibitors - adverse effects ; Reverse Transcriptase Inhibitors - therapeutic use ; Treatment Failure ; Viral Load - drug effects ; Young Adult</subject><ispartof>Journal of antimicrobial chemotherapy, 2016-10, Vol.71 (10), p.2918-2927</ispartof><rights>The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c389t-b90e6c3f8e842bf09831c050f1b236b213b894fbec67de642ff1fc3a5ffd7d073</citedby><cites>FETCH-LOGICAL-c389t-b90e6c3f8e842bf09831c050f1b236b213b894fbec67de642ff1fc3a5ffd7d073</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27342546$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Boender, T Sonia</creatorcontrib><creatorcontrib>Kityo, Cissy M</creatorcontrib><creatorcontrib>Boerma, Ragna S</creatorcontrib><creatorcontrib>Hamers, Raph L</creatorcontrib><creatorcontrib>Ondoa, Pascale</creatorcontrib><creatorcontrib>Wellington, Maureen</creatorcontrib><creatorcontrib>Siwale, Margaret</creatorcontrib><creatorcontrib>Nankya, Immaculate</creatorcontrib><creatorcontrib>Kaudha, Elizabeth</creatorcontrib><creatorcontrib>Akanmu, Alani Sulaimon</creatorcontrib><creatorcontrib>Botes, Mariette E</creatorcontrib><creatorcontrib>Steegen, Kim</creatorcontrib><creatorcontrib>Calis, Job C J</creatorcontrib><creatorcontrib>Rinke de Wit, Tobias F</creatorcontrib><creatorcontrib>Sigaloff, Kim C E</creatorcontrib><title>Accumulation of HIV-1 drug resistance after continued virological failure on first-line ART in adults and children in sub-Saharan Africa</title><title>Journal of antimicrobial chemotherapy</title><addtitle>J Antimicrob Chemother</addtitle><description>Limited availability of viral load (VL) monitoring in HIV treatment programmes in sub-Saharan Africa can delay switching to second-line ART, leading to the accumulation of drug resistance mutations (DRMs). The objective of this study was to evaluate the accumulation of resistance to reverse transcriptase inhibitors after continued virological failure on first-line ART, among adults and children in sub-Saharan Africa.
HIV-1-positive adults and children on an NNRTI-based first-line ART were included. Retrospective VL and, if VL ≥1000 copies/mL, pol genotypic testing was performed. Among participants with continued virological failure (≥2 VL ≥1000 copies/mL), drug resistance was evaluated.
At first virological failure, DRM(s) were detected in 87% of participants: K103N (38.7%), G190A (21.8%), Y181C (20.2%), V106M (8.4%), K101E (8.4%), any E138 (7.6%) and V108I (7.6%) associated with NNRTIs, and M184V (69.7%), any thymidine analogue mutation (9.2%), K65R (5.9%) and K70R (5.0%) associated with NRTIs. New DRMs accumulated with an average rate of 1.45 (SD 2.07) DRM per year; 0.62 (SD 1.11) NNRTI DRMs and 0.84 (SD 1.38) NRTI DRMs per year, respectively. The predicted susceptibility declined significantly after continued virological failure for all reverse transcriptase inhibitors (all P < 0.001). Acquired drug resistance patterns were similar in adults and children.
Patterns of drug resistance after virological failure on first-line ART are similar in adults and children in sub-Saharan Africa. Improved VL monitoring to prevent accumulation of mutations, and new drug classes to construct fully active regimens, are required.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Africa South of the Sahara - epidemiology</subject><subject>Anti-HIV Agents - administration & dosage</subject><subject>Anti-HIV Agents - adverse effects</subject><subject>Anti-HIV Agents - therapeutic use</subject><subject>Antiretroviral Therapy, Highly Active - adverse effects</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Drug Resistance, Viral - genetics</subject><subject>Female</subject><subject>HIV Infections - drug therapy</subject><subject>HIV Infections - epidemiology</subject><subject>HIV Infections - virology</subject><subject>HIV-1 - drug effects</subject><subject>HIV-1 - genetics</subject><subject>HIV-1 - isolation & purification</subject><subject>Humans</subject><subject>Male</subject><subject>Mutation</subject><subject>Retrospective Studies</subject><subject>Reverse Transcriptase Inhibitors - administration & dosage</subject><subject>Reverse Transcriptase Inhibitors - adverse effects</subject><subject>Reverse Transcriptase Inhibitors - therapeutic use</subject><subject>Treatment Failure</subject><subject>Viral Load - drug effects</subject><subject>Young Adult</subject><issn>0305-7453</issn><issn>1460-2091</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><recordid>eNo9kM1KAzEURoMotlY3PoBkKcLY_MzvshS1hYKg1e2QSW7a1DRTk4niG_jYTqm6unA531kchC4puaWk4uONkGP19sloeYSGNM1JwkhFj9GQcJIlRZrxAToLYUMIybO8PEUDVvCUZWk-RN8TKeM2WtGZ1uFW49n8NaFY-bjCHoIJnXASsNAdeCxb1xkXQeEP41vbrowUFmthbPSA-702PnSJNQ7w5GmJjcNCRdsFLJzCcm2s8uD27xCb5FmshRcOT7TvPefoRAsb4OL3jtDL_d1yOksWjw_z6WSRSF5WXdJUBHLJdQllyhpNqpJTSTKiacN43jDKm7JKdQMyLxTkKdOaaslFprUqFCn4CF0fvDvfvkcIXb01QYK1wkEbQ01LxvtuFc169OaASt-G4EHXO2-2wn_VlNT78nVfvj6U7-GrX29stqD-0b_U_Af2SYFR</recordid><startdate>20161001</startdate><enddate>20161001</enddate><creator>Boender, T Sonia</creator><creator>Kityo, Cissy M</creator><creator>Boerma, Ragna S</creator><creator>Hamers, Raph L</creator><creator>Ondoa, Pascale</creator><creator>Wellington, Maureen</creator><creator>Siwale, Margaret</creator><creator>Nankya, Immaculate</creator><creator>Kaudha, Elizabeth</creator><creator>Akanmu, Alani Sulaimon</creator><creator>Botes, Mariette E</creator><creator>Steegen, Kim</creator><creator>Calis, Job C J</creator><creator>Rinke de Wit, Tobias F</creator><creator>Sigaloff, Kim C E</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20161001</creationdate><title>Accumulation of HIV-1 drug resistance after continued virological failure on first-line ART in adults and children in sub-Saharan Africa</title><author>Boender, T Sonia ; Kityo, Cissy M ; Boerma, Ragna S ; Hamers, Raph L ; Ondoa, Pascale ; Wellington, Maureen ; Siwale, Margaret ; Nankya, Immaculate ; Kaudha, Elizabeth ; Akanmu, Alani Sulaimon ; Botes, Mariette E ; Steegen, Kim ; Calis, Job C J ; Rinke de Wit, Tobias F ; Sigaloff, Kim C E</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c389t-b90e6c3f8e842bf09831c050f1b236b213b894fbec67de642ff1fc3a5ffd7d073</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Africa South of the Sahara - epidemiology</topic><topic>Anti-HIV Agents - administration & dosage</topic><topic>Anti-HIV Agents - adverse effects</topic><topic>Anti-HIV Agents - therapeutic use</topic><topic>Antiretroviral Therapy, Highly Active - adverse effects</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Drug Resistance, Viral - genetics</topic><topic>Female</topic><topic>HIV Infections - drug therapy</topic><topic>HIV Infections - epidemiology</topic><topic>HIV Infections - virology</topic><topic>HIV-1 - drug effects</topic><topic>HIV-1 - genetics</topic><topic>HIV-1 - isolation & purification</topic><topic>Humans</topic><topic>Male</topic><topic>Mutation</topic><topic>Retrospective Studies</topic><topic>Reverse Transcriptase Inhibitors - administration & dosage</topic><topic>Reverse Transcriptase Inhibitors - adverse effects</topic><topic>Reverse Transcriptase Inhibitors - therapeutic use</topic><topic>Treatment Failure</topic><topic>Viral Load - drug effects</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Boender, T Sonia</creatorcontrib><creatorcontrib>Kityo, Cissy M</creatorcontrib><creatorcontrib>Boerma, Ragna S</creatorcontrib><creatorcontrib>Hamers, Raph L</creatorcontrib><creatorcontrib>Ondoa, Pascale</creatorcontrib><creatorcontrib>Wellington, Maureen</creatorcontrib><creatorcontrib>Siwale, Margaret</creatorcontrib><creatorcontrib>Nankya, Immaculate</creatorcontrib><creatorcontrib>Kaudha, Elizabeth</creatorcontrib><creatorcontrib>Akanmu, Alani Sulaimon</creatorcontrib><creatorcontrib>Botes, Mariette E</creatorcontrib><creatorcontrib>Steegen, Kim</creatorcontrib><creatorcontrib>Calis, Job C J</creatorcontrib><creatorcontrib>Rinke de Wit, Tobias F</creatorcontrib><creatorcontrib>Sigaloff, Kim C E</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of antimicrobial chemotherapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Boender, T Sonia</au><au>Kityo, Cissy M</au><au>Boerma, Ragna S</au><au>Hamers, Raph L</au><au>Ondoa, Pascale</au><au>Wellington, Maureen</au><au>Siwale, Margaret</au><au>Nankya, Immaculate</au><au>Kaudha, Elizabeth</au><au>Akanmu, Alani Sulaimon</au><au>Botes, Mariette E</au><au>Steegen, Kim</au><au>Calis, Job C J</au><au>Rinke de Wit, Tobias F</au><au>Sigaloff, Kim C E</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Accumulation of HIV-1 drug resistance after continued virological failure on first-line ART in adults and children in sub-Saharan Africa</atitle><jtitle>Journal of antimicrobial chemotherapy</jtitle><addtitle>J Antimicrob Chemother</addtitle><date>2016-10-01</date><risdate>2016</risdate><volume>71</volume><issue>10</issue><spage>2918</spage><epage>2927</epage><pages>2918-2927</pages><issn>0305-7453</issn><eissn>1460-2091</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>Limited availability of viral load (VL) monitoring in HIV treatment programmes in sub-Saharan Africa can delay switching to second-line ART, leading to the accumulation of drug resistance mutations (DRMs). The objective of this study was to evaluate the accumulation of resistance to reverse transcriptase inhibitors after continued virological failure on first-line ART, among adults and children in sub-Saharan Africa.
HIV-1-positive adults and children on an NNRTI-based first-line ART were included. Retrospective VL and, if VL ≥1000 copies/mL, pol genotypic testing was performed. Among participants with continued virological failure (≥2 VL ≥1000 copies/mL), drug resistance was evaluated.
At first virological failure, DRM(s) were detected in 87% of participants: K103N (38.7%), G190A (21.8%), Y181C (20.2%), V106M (8.4%), K101E (8.4%), any E138 (7.6%) and V108I (7.6%) associated with NNRTIs, and M184V (69.7%), any thymidine analogue mutation (9.2%), K65R (5.9%) and K70R (5.0%) associated with NRTIs. New DRMs accumulated with an average rate of 1.45 (SD 2.07) DRM per year; 0.62 (SD 1.11) NNRTI DRMs and 0.84 (SD 1.38) NRTI DRMs per year, respectively. The predicted susceptibility declined significantly after continued virological failure for all reverse transcriptase inhibitors (all P < 0.001). Acquired drug resistance patterns were similar in adults and children.
Patterns of drug resistance after virological failure on first-line ART are similar in adults and children in sub-Saharan Africa. Improved VL monitoring to prevent accumulation of mutations, and new drug classes to construct fully active regimens, are required.</abstract><cop>England</cop><pmid>27342546</pmid><doi>10.1093/jac/dkw218</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Adolescent Adult Africa South of the Sahara - epidemiology Anti-HIV Agents - administration & dosage Anti-HIV Agents - adverse effects Anti-HIV Agents - therapeutic use Antiretroviral Therapy, Highly Active - adverse effects Child Child, Preschool Drug Resistance, Viral - genetics Female HIV Infections - drug therapy HIV Infections - epidemiology HIV Infections - virology HIV-1 - drug effects HIV-1 - genetics HIV-1 - isolation & purification Humans Male Mutation Retrospective Studies Reverse Transcriptase Inhibitors - administration & dosage Reverse Transcriptase Inhibitors - adverse effects Reverse Transcriptase Inhibitors - therapeutic use Treatment Failure Viral Load - drug effects Young Adult |
title | Accumulation of HIV-1 drug resistance after continued virological failure on first-line ART in adults and children in sub-Saharan Africa |
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