High-Levels of Acquired Drug Resistance in Adult Patients Failing First-Line Antiretroviral Therapy in a Rural HIV Treatment Programme in KwaZulu-Natal, South Africa. PLoS One, 8(8): e72152 (2013).

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Title: High-Levels of Acquired Drug Resistance in Adult Patients Failing First-Line Antiretroviral Therapy in a Rural HIV Treatment Programme in KwaZulu-Natal, South Africa
Authors: Manasa J, Lessells RJ, Skingsley A, Naidu KK, Newell M-L, McGrath N, de Oliveira T.
Journal: PLoS One,8(8):e72152 (2013)

Journal Impact Factor (I.F.): 4.411
Number of citations (Google Scholar): 27

Abstract

Objective

To determine the frequency and patterns of acquired antiretroviral drug resistance in a rural primary health care programme in South Africa.

Design

Cross-sectional study nested within HIV treatment programme.

Methods

Adult (>=18 years) HIV-infected individuals initially treated with a first-line stavudine- or zidovudine-based antiretroviral therapy (ART) regimen and with evidence of virological failure (one viral load >1000 copies/ml) were enrolled from 17 rural primary health care clinics. Genotypic resistance testing was performed using the in-house SATuRN/Life Technologies system. Sequences were analysed and genotypic susceptibility scores (GSS) for standard second-line regimens were calculated using the Stanford HIVDB 6.0.5 algorithms.

Results

A total of 222 adults were successfully genotyped for HIV drug resistance between December 2010 and March 2012. The most common regimens at time of genotype were stavudine, lamivudine and efavirenz (51%); and stavudine, lamivudine and nevirapine (24%). Median duration of ART was 42 months (interquartile range (IQR) 32-53) and median duration of antiretroviral failure was 27 months (IQR 17-40). One hundred and ninety one (86%) had at least one drug resistance mutation. For 34 individuals (15%), the GSS for the standard second-line regimen was <2, suggesting a significantly compromised regimen. In univariate analysis, individuals with a prior nucleoside reverse-transcriptase inhibitor (NRTI) substitution were more likely to have a GSS <2 than those on the same NRTIs throughout (odds ratio (OR) 5.70, 95% confidence interval (CI) 2.60-12.49).

Conclusions

There are high levels of drug resistance in adults with failure of first-line antiretroviral therapy in this rural primary health care programme. Standard second-line regimens could potentially have had reduced efficacy in about one in seven adults involved.

Download: Full text paper

Citation: Manasa J, Lessells RJ, Skingsley A, Naidu KK, Newell M-L, McGrath N, de Oliveira T. High-Levels of Acquired Drug Resistance in Adult Patients Failing First-Line Antiretroviral Therapy in a Rural HIV Treatment Programme in KwaZulu-Natal, South Africa PLoS One,8(8):e72152 (2013).

Video/Movie


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Interview about a paper that show very high-level of HIV-1 drug resistance in Adults in Hlabisa, rural KZN, South Africa


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Printed and Online Media Coverage

Los Angeles Times

HIV drug resistance is spreading in Africa, experts say

Los Angeles Times - 2012-07-23

WASHINGTON (By Erin Loury, LA Times) - Scaling up the distribution of HIV medication over the last decade has vastly increased the number of people receiving treatment around the world. An estimated 8 million infected people received the antiretroviral drugs in 2011, compared to just 400,000 in 2003.


SATuRN

Newsletter, Oct 2013: News, blogs, manuscripts & Youtube videos!

SATuRN - 2013-10-01

The concept behind this newsletter is that anyone with 15 minutes to spare can learn about the work of SATuRN. In this third issue of 2013 our newsletter we focus on our digital videos activities. We have also included interesting news, blogs, reports, tweets, publications and training information produced by our network.



Mutational Correlates of Virological Failure in Individuals Receiving a WHO-Recommended Tenofovir-Containing First-Line Regimen: An International Collaboration
Journal: EBioMedicine (2017)

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
Journal: Clinical Infectious Diseases (2017)

Virological Outcomes of Second-line Protease Inhibitor-Based Treatment for Human Immunodeficiency Virus Type 1 in a High-Prevalence Rural South African Setting: A Competing-Risks Prospective Cohort Analysis
Journal: Clinical Infectious Diseases (2017)
All publications...


KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), K-RITH Tower Building, Nelson R Mandela School of Medicine, UKZN

Contact: Prof. Tulio de Oliveira, Tel: +27 31 260 4898, Email: tuliodna@gmail.com & deoliveira@ukzn.ac.za

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