Antiretroviral drug resistance among antiretroviral‐naïve persons with recent HIV infection in Thailand

Abstract

ObjectivesTo evaluate the prevalence and patterns of antiretroviral (ARV) drug resistance (ARV-DR) among ARV drug-naïve, recently infected persons with HIV in the 4-year interval (2003)(2004)(2005)(2006) after the inception of the National Access to ARV Programme for People who have AIDS in Thailand. MethodsCross-sectional study of patients with recent HIV infection for HIV risks, ARV-DR risks and baseline ARV-DR. ResultsSeven of the 305 patients (2%) had baseline ARV-DR. Via contract tracing, all seven patients with transmitted ARV-DR identified sexual partners with prior ARV treatment failure and had documented low (o75%) ARV adherence. Annual ARV-DR increased from 0 to 5.2% (P 5 0.06) between 2003 and 2006. ConclusionsReport of sexual partners with potential HIV and ARV drug exposures can prompt baseline ARV-DR testing of at-risk individuals, while behavioural interventions for adherence and safer sex are refined to minimize the emergence of resistance to generic, fixed-dose combination stavudine, lamivudine and nevirapine (GPO-VIR) therapy.

Comparisons of Primary HIV-1 Drug Resistance between Recent and Chronic HIV-1 Infection within a Sub-Regional Cohort of Asian Patients

“…In this study, the prevalence of primary HIVDR in patients with recent infection was higher than that found in previous surveys of primary HIVDR in this region [8], [21], [22], [27]. However, the recent study in Thailand showed that primary resistance among men who have sex with men was approximately 7% [28].…”

“…Previous reports of primary HIVDR among Asian patients ranged from 0% to 13.8% [8], [9], [21]–[24]. Results have varied by study methodology, route of HIV-1 transmission, duration of HIV-1 infection, HIV-1 subtype, pattern of local ART regimen use, and the reference list of RAMs used to assess the presence of relevant HIVDR mutations [4], [25], [26].…”

“…Primary HIVDR, pre-existing resistance in those who have not received ART [6], [7], is increasing in settings where ART has been widely available for longer periods of time due to a greater likelihood of acquired resistance-associated mutations (RAMs) in the pool of transmissible virus [5], [8], [9]. The transmission of drug-resistant virus is a growing concern, and has been associated with increased mortality, morbidity, and medical expenditures because of compromising the effectiveness of first-line ART regimens [4], [10], [11].…”

HIV-1 Drug Resistance Mutations Are Present in Six Percent of Persons Initiating Antiretroviral Therapy in Lusaka, Zambia

“…19 Population surveys [7][8][9][10][11][12] and mathematical models 20 to date have reported low levels of drug-resistant infections in African populations with increasing selective ARV drug pressure, but recent preliminary reports have suggested transmission of resistant strains directly after national ARV rollout programs. 21,22 The predominance of NNRTI-associated DRMs (mostly Y181C and K103N/S) in this baseline study probably results from the widespread use of NNRTIs as part of standard first-line ART and PMTCT regimens. Most solitary NNRTIassociated DRMs cause a complete loss of activity of efavirenz and nevirapine, 23 which may compromise the initial response to the standard first-line therapy.…”

Hidden Drug Resistant HIV to Emerge in the Era of Universal Treatment Access in Southeast Asia

“…Documented rates of transmitted drug resistance include 4% in 2003–2004 in Japan [7] and increases in Taiwan from 6.6% in 1999–2003 to 12.7% in 2003–2006 [8] and Thailand from <1% in 2003 to 5.2% in 2006 [9]. The vast majority of patients (∼80%) in Asia start treatment on AZT/d4T plus 3TC plus EFZ/NVP [10].…”