Compromise of Second-Line Antiretroviral Therapy Due to High Rates of Human Immunodeficiency Virus Drug Resistance in Mozambican Treatment-Experienced Children With Virologic Failure

Buck, W Chris; Bhatt, Nilesh; Bila, Dulce; Auld, Andrew F.; Houston, James; Cossa, Loide; Alfredo, Charity; Jobarteh, Kebba; Sabatier, Jennifer; Macassa, Eugenia; Sousa, Amina de; DeVos, Josh; Jani, Ilesh; Yang, Chunfu

doi:10.1093/jpids/piy102

Cited by 6 publications

(10 citation statements)

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“…These findings are of particular concern, because they could indicate inadequate EAC and/or a high level of treatment failure due to drug resistance that requires switching the ART regimen. It is known that prolonged treatment regimen failure significantly increases the risk of multiple drug-resistant mutations and compromises the efficacy of second-line ART in HIV-infected children [ 63 ], adults [ 64 ], and pregnant women [ 65 ]. PLHIV on ART who fail to achieve viral suppression enter a “failure cascade” that can jeopardise individual health and the overall effectiveness of HIV programs [ 66 ].…”

Section: Discussionmentioning

confidence: 99%

Viral load monitoring for people living with HIV in the era of test and treat: progress made and challenges ahead – a systematic review

et al. 2022

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Background In 2016, we conducted a systematic review to assess the feasibility of treatment monitoring for people living with HIV (PLHIV) receiving antiretroviral therapy (ART) in low and middle-income countries (LMICs), in line with the 90-90-90 treatment target. By 2020, global estimates suggest the 90-90-90 target, particularly the last 90, remains unattainable in many LMICs. This study aims to review the progress and identify needs for public health interventions to improve viral load monitoring and viral suppression for PLHIV in LMICs. Methods A literature search was conducted using an update of the initial search strategy developed for the 2016 review. Electronic databases (Medline and PubMed) were searched to identify relevant literature published in English between Dec 2015 and August 2021. The primary outcome was initial viral load (VL) monitoring (the proportion of PLHIV on ART and eligible for VL monitoring who received a VL test). Secondary outcomes included follow-up VL monitoring (the proportion of PLHIV who received a follow-up VL after an initial elevated VL test), confirmation of treatment failure (the proportion of PLHIV who had two consecutive elevated VL results) and switching treatment regimen rates (the proportion of PLHIV who switched treatment regimen after confirmation of treatment failure). Results The search strategy identified 1984 non-duplicate records, of which 34 studies were included in the review. Marked variations in initial VL monitoring coverage were reported across study settings/countries (range: 12–93% median: 74% IQR: 46–82%) and study populations (adults (range: 25–96%, median: 67% IQR: 50–84%), children, adolescents/young people (range: 2–94%, median: 72% IQR: 47–85%), and pregnant women (range: 32–82%, median: 57% IQR: 43–71%)). Community-based models reported higher VL monitoring (median: 85%, IQR: 82-88%) compared to decentralised care at primary health facility (median: 64%, IRQ: 48-82%). Suboptimal uptake of follow-up VL monitoring and low regimen switching rates were observed. Conclusions Substantial gaps in VL coverage across study settings and study populations were evident, with limited data availability outside of sub-Saharan Africa. Further research is needed to fill the data gaps. Development and implementation of innovative, community-based interventions are required to improve VL monitoring and address the “failure cascade” in PLHIV on ART who fail to achieve viral suppression.

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Section: Discussionmentioning

confidence: 99%

Viral load monitoring for people living with HIV in the era of test and treat: progress made and challenges ahead – a systematic review

et al. 2022

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“…Moreover, one and half million people were newly infected, and more than half a million people died from HIV-related causes in 2020 [ 1 ]. Nearly three-fourth of PLWH had access to ART [ 2 , 3 ]. The Global Burden of Disease estimated that HIV/AIDS was the eleventh common cause of disability-adjusted Life-years globally in 2019 –the second top cause for 25–49 years old, and the ninth for 10–24 years old [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…Studies also reported that the HIVDR is found to be a problem among people who are ART-naïve starting first-line ART [ 17 , 18 ]. This situation limits the treatment outcome in individuals who are on the first-line ART regimen [ 19 ]. The resistance to first-line ART drugs would also affect effectiveness of second-line ART drugs [ 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

“…This situation limits the treatment outcome in individuals who are on the first-line ART regimen [ 19 ]. The resistance to first-line ART drugs would also affect effectiveness of second-line ART drugs [ 19 , 20 ]. And more recently, there are evidence revealing a high rate of drug resistance compromised the efficacy of second-line ART regimens.…”

Section: Introductionmentioning

confidence: 99%

“…And more recently, there are evidence revealing a high rate of drug resistance compromised the efficacy of second-line ART regimens. Alarmingly, the burden of HIVDR is more prevalent in those individuals who are on second-line ART than those who are on the first-line ART regimen [ 19 ]. A retrospective study conducted in Zimbabwe on adolescents and adults who failed the first-line ART regimens demonstrated a high level of drug resistance mutations despite enhanced adherence counselling and switching to the second-line regiment [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

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Magnitude and predictors of HIV-Drug resistance in Africa: A protocol for systematic review and meta-analysis

2022

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Introduction Human Immunodeficiency Virus (HIV) is continued to be a major public health problem in low-income countries and more importantly in Africa. For the last decade, access to Antiretroviral Therapy (ART) and its impact in improving quality of life and reducing HIV-related morbidity and mortality has significantly been improved in Africa. Nevertheless, the emergency of HIV drug resistance (HIVDR) has posed challenges in achieving optimal ART treatment outcomes and is alarmingly increasing globally in general and in Africa in particular. Comprehensive epidemiological data on the magnitude of HIVDR and HIVDR mutations, and predictors of HIVDR are, however, limited in Africa. Objective The main objective of this systematic review will be to estimate the pooled proportion of HIVDR and HIVDR mutations, and identify factors associated with HIVDR among people living with HIV/AIDS (PLWH) in Africa. Method Published Literature from 2000 until 30 October 2021 will be searched in PubMed/Medline Ovid, HINARI, SCOPUS, EMBASE, CINAHL, Web of Sciences, and Cochrane electronic databases. Initially, the literature will be screened based on title/abstract and followed by full-text appraisal for methodological quality using JBI critical appraisal tools. Data will be extracted from eligible articles after the full-text appraisal. Heterogeneity will be qualitatively assessed by a visual Funnel plot and quantitatively measured by an index of heterogeneity (I2 statistics). Random-effects model will be fitted to estimate the proportion of HIVDR and each HIVDR mutations. Sub-group and sensitivity analyses will be conducted to reduce heterogeneity. Meta-regression will be done by median year of sampling per study to observe the pattern of changes over time. Publication bias will be assessed by egger’s statistics. In case of publication bias, Trim and Fill analysis will be conducted to overcome small-study effect. Data analysis will be performed using Stata version 14. Ethics and dissemination As the data sources are published papers, the protocol will not require an ethical approval letter. The final report of the review will be published in a peer-reviewed journal.

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Point-of-care HIV viral load and targeted drug resistance mutation testing versus standard care for Kenyan children on antiretroviral therapy (Opt4Kids): an open-label, randomised controlled trial

Patel

Oyaro²,

Thomas

et al. 2022

The Lancet Child & Adolescent Health

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Compromise of Second-Line Antiretroviral Therapy Due to High Rates of Human Immunodeficiency Virus Drug Resistance in Mozambican Treatment-Experienced Children With Virologic Failure

Cited by 6 publications

References 36 publications

Viral load monitoring for people living with HIV in the era of test and treat: progress made and challenges ahead – a systematic review

Viral load monitoring for people living with HIV in the era of test and treat: progress made and challenges ahead – a systematic review

Magnitude and predictors of HIV-Drug resistance in Africa: A protocol for systematic review and meta-analysis

Point-of-care HIV viral load and targeted drug resistance mutation testing versus standard care for Kenyan children on antiretroviral therapy (Opt4Kids): an open-label, randomised controlled trial

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