Antiretroviral-Drug Resistance among Patients Recently Infected with HIV

Little, Susan J.; Holte, Sarah; Routy, Jean Pierre; Daar, Eric S.; Markowitz, Marty; Collier, Ann C.; Koup, Richard A.; Mellors, John W.; Connick, Elizabeth; Conway, Brian; Kilby, Michael; Wang, Lei; Whitcomb, Jeannette M.; Hellmann, Nicholas S.; Richman, Douglas D.

doi:10.1056/nejmoa013552

Cited by 1,037 publications

(815 citation statements)

References 39 publications

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“…In America and Europe, about 10% of recent HIV-1 infections are drug resistant HIV-1 strains [4]. In Canada, the prevalence of drug-resistant HIV-1 strains among recent infected individuals increased from 5.5% at 1995-1998 to 18.5% at 1999-2000 and 27.6% at 2001.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and evolution of drug resistance HIV-1 variants in Henan, China

et al. 2005

Cell Res

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ABSTACTTo understand the prevalence and evolution of drug resistant HIV strains in Henan China after the implementation of free antiretroviral therapy for AIDS patients. 45 drug naïve AIDS patients, 118 AIDS patients who received three months antiretroviral therapy and 124 AIDS patients who received six months antiretroviral treatment were recruited in the southern part of Henan province. Information on general condition, antiretroviral medicines, adherence and clinical syndromes were collected by face to face interview. Meanwhile, 14ml EDTA anticoagulant blood was drawn. CD4/CD8 T cell count, viral load and genotypic drug resistance were tested. The rates of clinical improvement were 55.1% and 50.8% respectively three months and six months after antiretroviral therapy. The mean CD4 cell count after antiretroviral therapy was significantly higher than in drug naïve patients. The prevalence rate of drug resistant HIV strains were 13. 9%, 45.4% and 62.7% in drug naïve patients, three month treatment patients and six month treatment patients, respectively. The number of resistance mutation codons and the frequency of mutations increased significantly with continued antiretroviral therapy. The mutation sites were primarily at the 103, 106 and 215 codons in the three-month treatment group and they increased to 15 codon mutations in the six-month treatment group. From this result, the evolution of drug resistant strains was inferred to begin with the high level NNRTI resistant strain, and then develop low level resistant strains to NRTIs. The HIV strains with high level resistance to NVP and low level resistance to AZT and DDI were highly prevalent because of the AZT+DDI+NVP combination therapy. These HIV strains were also cross resistant to DLV, EFV, DDC and D4T. Poor adherence to therapy was believed to be the main reason for the emergence and prevalence of drug resistant HIV strains. The prevalence of drug resistant HIV strains was increased with the continuation of antiretroviral therapy in the southern part of Henan province. Measures, that could promote high level adherence, provide new drugs and change ART regimens in failing patients, should be implemented as soon as possible.

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Section: Introductionmentioning

confidence: 99%

Prevalence and evolution of drug resistance HIV-1 variants in Henan, China

et al. 2005

Cell Res

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“…A number of studies in other countries have shown that the prevalence of viruses with drug resistance mutations in acutely or recently infected persons varies from 10 to 20% [33][34][35]. Research examining the prevalence and genetic features of drug-resistance strains at national level is lacking in China.…”

Section: Anti-hiv Therapy Drug Resistance and Its Dissemination In Cmentioning

confidence: 99%

Snapshot of HIV pathogenesis in China

et al. 2005

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Several reviews have focused on the nature of HIV infection and its spread in various geographical regions of China. In contrast, this review provides a comprehensive update on the prevalence of multiple HIV-1 subtypes, consequent emergence of recombinant and novel forms of HIV-1 in China, and the implications this may have on HIV diversity and the development of effective vaccines. In addition it also examines the dissemination of primary drug resistance in therapy naïve patients, as well as co-infections with two other important viruses-hepatitis B and C. The main purpose of this review is to provide a current snapshot of HIV-1 pathogenesis in China and possibly shed some light on the future of HIV evolution, and potential challenges for future vaccine and anti-retroviral therapeutics against HIV strains in this area.

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“…These agents have been chosen in developing countries due to their ease of administration, costs, and potency. Resistance to EFV and NVP has been shown to develop rapidly in clinical use and has been documented to occur in up to 15% of patients with primary/early HIV infection and no history of exposure to antiretroviral therapy [7]. In addition, we are recognizing the fact that high rates of resistance to NNRTIs occur after single dose NVP is given for PMTCT [40].…”

Section: Key Principles and Complexities Of Antiretroviral Therapymentioning

confidence: 99%

“…However, the success rates in real life clinic settings have been much lower [6]. This has led to an increase in the prevalence of resistance mutations in both those on ART and those who are newly infected [7,8]. Indeed, a report in this issue demonstrates that 62.7% of patients developed ARV drug resistance after only 6 months of ART in one region in China [9].…”

Section: Introductionmentioning

confidence: 99%

Approaches to antiretroviral therapy in China

Gilliam

Redfield

2005

Cell Res

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China has recognized the threat of HIV to its population and responded with a national antiretroviral treatment (ART) program. However, high ART failure rates and the spread of resistance within populations are important realities to consider when developing and managing ART programs in China and worldwide. Concepts which will define treatment success and local and national programmatic goals are 1) access to ART, 2) durability of ART at the patient level, 3) scalability of treatment modalities, and the 4) sustainability of the program at the community or national level. In the face of limited resources, China must also consider when to start ARV therapy, which agents to use, when to switch them, and how to treat highly experienced patients with drug resistance. The optimal ARV regimen to start with is changing frequently with the introduction of new agents and the presentation of new data. Currently, a regimen including tenofovir, emtricitabine or lamivudine and a nonnucleoside reverse transcriptase inhibitor appears to have optimal characteristics to treat HIV/AIDS in China. However, critical to all of these choices is the evaluation of programs implemented to insure wide scale success. China has wisely begun this process of evaluating the performance of local programs through systematic monitoring and evaluation of treatment outcomes. This will allow regimens and programs that work to be expanded, and programs with high failure rates to be eliminated. In the end, evidence based data supporting treatment strategies will allow China to successfully confront its AIDS epidemic early and prevent its tragic consequences

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Antiretroviral-Drug Resistance among Patients Recently Infected with HIV

Cited by 1,037 publications

References 39 publications

Prevalence and evolution of drug resistance HIV-1 variants in Henan, China

Prevalence and evolution of drug resistance HIV-1 variants in Henan, China

Snapshot of HIV pathogenesis in China

Approaches to antiretroviral therapy in China

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