HIV-1 drug resistance in adults and adolescents on protease inhibitor-based antiretroviral therapy in KwaZulu-Natal Province, South Africa
<p><strong>Objectives: </strong>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 (AR...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
Elsevier
2021
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| _version_ | 1826311159236526080 |
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| author | Chimukangara, B Lessells, RJ Sartorius, B Gounder, L Manyana, S Pillay, M Singh, L Giandhari, J Govender, K Samuel, R Msomi, N Naidoo, K de Oliveira, T Moodley, P Parboosing, R |
| author_facet | Chimukangara, B Lessells, RJ Sartorius, B Gounder, L Manyana, S Pillay, M Singh, L Giandhari, J Govender, K Samuel, R Msomi, N Naidoo, K de Oliveira, T Moodley, P Parboosing, R |
| author_sort | Chimukangara, B |
| collection | OXFORD |
| description | <p><strong>Objectives: </strong>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.</p>
<p><strong>Methods: </strong>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.</p>
<p><strong>Results: </strong>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.</p>
<p><strong>Conclusion: </strong>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.</p> |
| first_indexed | 2024-03-07T08:04:13Z |
| format | Journal article |
| id | oxford-uuid:d486dae5-250e-4be3-acd9-628a833d001f |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T08:04:13Z |
| publishDate | 2021 |
| publisher | Elsevier |
| record_format | dspace |
| spelling | oxford-uuid:d486dae5-250e-4be3-acd9-628a833d001f2023-10-18T06:52:38ZHIV-1 drug resistance in adults and adolescents on protease inhibitor-based antiretroviral therapy in KwaZulu-Natal Province, South AfricaJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:d486dae5-250e-4be3-acd9-628a833d001fEnglishSymplectic ElementsElsevier2021Chimukangara, BLessells, RJSartorius, BGounder, LManyana, SPillay, MSingh, LGiandhari, JGovender, KSamuel, RMsomi, NNaidoo, Kde Oliveira, TMoodley, PParboosing, R<p><strong>Objectives: </strong>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.</p> <p><strong>Methods: </strong>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.</p> <p><strong>Results: </strong>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.</p> <p><strong>Conclusion: </strong>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.</p> |
| spellingShingle | Chimukangara, B Lessells, RJ Sartorius, B Gounder, L Manyana, S Pillay, M Singh, L Giandhari, J Govender, K Samuel, R Msomi, N Naidoo, K de Oliveira, T Moodley, P Parboosing, R HIV-1 drug resistance in adults and adolescents on protease inhibitor-based antiretroviral therapy in KwaZulu-Natal Province, South Africa |
| title | HIV-1 drug resistance in adults and adolescents on protease inhibitor-based antiretroviral therapy in KwaZulu-Natal Province, South Africa |
| title_full | HIV-1 drug resistance in adults and adolescents on protease inhibitor-based antiretroviral therapy in KwaZulu-Natal Province, South Africa |
| title_fullStr | HIV-1 drug resistance in adults and adolescents on protease inhibitor-based antiretroviral therapy in KwaZulu-Natal Province, South Africa |
| title_full_unstemmed | HIV-1 drug resistance in adults and adolescents on protease inhibitor-based antiretroviral therapy in KwaZulu-Natal Province, South Africa |
| title_short | HIV-1 drug resistance in adults and adolescents on protease inhibitor-based antiretroviral therapy in KwaZulu-Natal Province, South Africa |
| title_sort | hiv 1 drug resistance in adults and adolescents on protease inhibitor based antiretroviral therapy in kwazulu natal province south africa |
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