Emergence of untreatable, multidrug-resistant HIV-1 in patients failing second-line therapy in Kenya

Abstract

: We performed a countrywide assessment of HIV drug resistance among 123 patients with virological failure on second-line antiretroviral therapy (ART) in Kenya. The percentage of patients harbouring intermediate-to-high-level resistance was 27% for lopinavir-ritonavir, 24% for atazanavir-ritonavir and 7% for darunavir-ritonavir, and 25% had complete loss of activity to all available first and second-line drugs. Overall, one in four patients failing second-line ART have completely exhausted available antiretrovirals in Kenya, highlighting the need for increased access to third-line drugs.

Human Immunodeficiency Virus Type 1 Drug Resistance Mutations Update

“…Approximately 5%-10% of patients with VF while receiving bLPV and bATV, and 2% of patients with VF while receiving bDRV, as an initial boosted PI develop PI resistance mutations [31][32][33][34][35][36]. In patients receiving bLPV who develop PI resistance mutations, the following have each been reported in >5% of patients: V32I, M46I/L, I47A/V, I50V, I54V, L76V, V82A, I84V, and L90M [31,[37][38][39][40].…”

Increased acquired protease inhibitor drug resistance mutations in minor HIV-1 quasispecies from infected patients suspected of failing on national second-line therapy in South Africa

“…Furthermore, a study conducted in Nigeria reported PI RAMs in 62% of patients receiving PI-based second-line cART, with GRT being limited to patients with good adherence [24]. In East Africa, Inzaule et al's [25] study found one or more major PI resistance mutations in 32% of unselected Kenyan patients with second-line ART failure and a median duration on PI-based ART of 3.1 years [25]. Few other observational studies in the African region have reported on ART exhaustion in 9 to 32% of patients failing second-line therapy [26,27].…”

HIV‐1 drug resistance testing at second‐line regimen failure in Arua, Uganda: avoiding unnecessary switch to an empiric third‐line

“…In other words, without DRT, more than 60% of patients with VF included would have been unnecessarily switched to third‐line ART. Recent studies also reported a significant proportion of second‐line failure without major resistance to the current regimen and poor adherence was indicated as a major factor underlying VF .…”