Publication

Title: High Rates of Transmission of Drug-resistant HIV in Aruba Resulting in Reduced Susceptibility to the WHO Recommended First-line Regimen in Nearly Half of Newly Diagnosed HIV-infected Patients
Authors: Hofstra LM, Rivas ES, Nijhuis M, Bank LEA, Wilkinson E, Kelly K, Mudrikova T, Schuurman R, de Oliveira T, de Kort J, Wensing AMJ.
Journal: Clinical Infectious Diseases,:doi: 10.1093/cid/cix056 (2017)

Journal Impact Factor (I.F.): 8.88
Number of citations (Google Scholar): 5

Abstract

BACKGROUND: In Western countries emergence of human immunodeficiency virus (HIV) drug resistance has tremendously decreased, and transmission of drug resistance has merely stabilized in recent years. However, in many endemic settings with limited resources rates of emerging and transmitted drug resistance are not regularly assessed.

METHODS: We performed a survey including all HIV-infected individuals who received resistance testing in 2010-2015 in Aruba, a highly endemic HIV area in the Caribbean. Transmitted HIV drug resistance was determined using World Health Organization (WHO) criteria. Transmission dynamics were investigated using phylogenetic analyses. In a subset, baseline samples were re-analyzed using next generation sequencing (NGS).

RESULTS: Baseline resistance testing was performed in 104 newly diagnosed untreated individuals (54% of all newly diagnosed individuals in 2010-2015): 86% were men, 39% were foreign-born, and 22% had AIDS at diagnosis. And 33% (95% CI: 24-42%) was infected with a drug-resistant HIV variant. The prevalence of resistance to non-nucleoside reverse transcriptase inhibitors (NNRTIs) reached 45% (95% CI: 27-64%) in 2015, all based on the prevalence of mutation K103N. NGS did not demonstrate additional minority K103N-variants compared to routine resistance testing. K103N-harboring strains were introduced into the therapy-unexposed population via at least 6 independent transmissions epidemiologically linked to the surrounding countries. Virological failure of the WHO-recommended first-line NNRTI-based regimen was higher in the presence of K103N.

CONCLUSIONS: The prevalence of resistant HIV in Aruba has increased to alarming levels, compromising the WHO-recommended first-line regimen. As adequate surveillance as advocated by the WHO is limited, the Caribbean region could face an unidentified rise of NNRTI-resistant HIV.

Download: Full text paper

Citation: Hofstra LM, Rivas ES, Nijhuis M, Bank LEA, Wilkinson E, Kelly K, Mudrikova T, Schuurman R, de Oliveira T, de Kort J, Wensing AMJ. High Rates of Transmission of Drug-resistant HIV in Aruba Resulting in Reduced Susceptibility to the WHO Recommended First-line Regimen in Nearly Half of Newly Diagnosed HIV-infected Patients Clinical Infectious Diseases,:doi: 10.1093/cid/cix056 (2017).

Printed and Online Media Coverage

Healio News

Prevalence of drug-resistant HIV reaches 'alarming levels' in ArubaHealio News - 2017-03-17

The prevalence of resistance to nonnucleoside reverse transcriptase inhibitors among HIV-infected individuals has increased to 'alarming levels' in Aruba, reaching 45% in 2015, see our recent publication at CID.


Healio News: IAS Perspective

Perspective: Extreme high-level of drug resistance in Aruba: We need ITI-based regimens available globally now!Healio News: IAS Perspective - 2017-03-17

Perspective by Carlos del Rio, MD Professor of medicine, division of infectious diseases, Emory University School of Medicine on our recent CID manuscript on high-level transmitted resistance epidemic in Aruba.