High Prevalence of NRTI and NNRTI Drug Resistance Among ART-Experienced, Hospitalized Inpatients

Bossard, Claire; Schramm, Birgit; Wanjala, Stephen; Jain, Lakshmi; Mucinya, Gisele; Opollo, Valarie; Wiesner, Lubbe; Cutsem, Gilles van; Poulet, Elisabeth; Szumilin, Elisabeth; Ellman, Tom; Maman, David

doi:10.1097/qai.0000000000002689

Cited by 6 publications

(3 citation statements)

References 22 publications

(30 reference statements)

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“…However, among all the identified strains, 3.02%, 45.48% and 63.32% HIV-1 viruses were confirmed resistance to PIs, NRTIs and NNRTIs. The drug resistance rates of NRTIs and NNRTIs were similar to previous studies in other countries [ 18 , 20 ]. For example, the resistance rates of NRTIs and NNRTIs were 83.0% and 88.7% among treatment failures in Philippines.…”

Section: Discussionsupporting

confidence: 87%

Genetic characterization of HIV-1 viruses among cases with antiretroviral therapy failure in Suzhou City, China

Dong¹,

Xu²,

Zhou

et al. 2023

AIDS Res Ther

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Background This retrospective study aimed to characterize the distribution of HIV-1 genotypes and the prevalence of drug resistance mutations in people with antiretroviral treatment (ART) failure in Suzhou City, China. Methods Pol gene of HIV-1 viruses in blood samples of EDTA anticoagulants from 398 patients with failed antiviral treatment was successfully amplified by using an in-house assay. Drug resistance mutations were analyzed by using the Stanford HIV Drug Resistance Database system (https://hivdb.stanford.edu/hivdb/by-mutations/). HIV-1 genotypes were determined by the REGA HIV subtyping tool (version 3.46, https://www.genomedetective.com/app/typingtool/hiv). Near full-length genomes (NFLG) of HIV-1 viruses were obtained by next generation sequencing method. Results Sequences analysis of the pol gene revealed that CRF 01_AE (57.29%, 228/398) was the dominant subtype circulating in Suzhou City, followed by CRF 07_BC (17.34%, 69/398), subtype B (7.54%, 30/398), CRF 08_BC (6.53%, 26/398), CRF 67_01B (3.02%, 12/398) and CRF55_01B (2.51%, 10/398). The overall prevalence of drug-resistant mutations in cases with ART failure was 64.57% (257/398), including 45.48% (181/398) for nucleotide reverse transcriptase inhibitors (NRTIs) mutations, 63.32% (252/398) for non-nucleoside reverse transcriptase inhibitors (NNRTIs) mutations, and 3.02% (12/398) for protease inhibitors (PIs) mutations. Ten near full-length genomes (NFLG) of HIV-1 viruses were identified, including six recombinants of CRF 01_AE and subtype B, two recombinants of CRF 01_AE, subtype B and subtype C sequences, one recombinant of CRF 01_AE and subtype C and one recombinant of CRF 01_AE, subtype A1 and subtype C. Conclusions The high prevalence of drug-resistant HIV-1 viruses was a serious challenge for HIV prevention and treatment of people with HIV infection. Treatment regimens for ART failure patients should be adjusted over time based on the outcome of drug resistance tests. NFLG sequencing facilitates the identification of new recombinants of HIV-1.

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Section: Discussionsupporting

confidence: 87%

Genetic characterization of HIV-1 viruses among cases with antiretroviral therapy failure in Suzhou City, China

Dong¹,

Xu²,

Zhou

et al. 2023

AIDS Res Ther

View full text Add to dashboard Cite

show abstract

“…However, among all the identi ed strains, 3.02%, 45.48% and 63.32% HIV-1 viruses were con rmed resistance to PIs, NRTIs and NNRTIs. The drug resistance rates of NRTIs and NNRTIs were similar to previously studies in other countries [20,21]. For example, the resistance rates of NRTIs and NNRTIs were 83.0% and 88.7% among treatment failures in Philippines.…”

Section: Discussionsupporting

confidence: 86%

Genetic characterization of HIV-1 viruses among antiretroviral therapy failure individuals in Suzhou City, China

Dong

TIAN

et al. 2022

Preprint

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Background: This retrospective study was aimed to characterize the distribution of HIV-1 genotypes and prevalence of drug-resistance mutations in antiretroviral therapy (ART) failure individuals in Suzhou City, China. Methods: Polgene of HIV-1 viruses in EDTA anticoagulant plasma samples of 398 ART failure HIV-infected individuals were successfully amplified by using an in-house assay. Drug resistance mutations were analyzed by using the Stanford HIV Drug Resistance Database system (https://hivdb.stanford.edu/hivdb/by-mutations/). HIV-1 genotypes were determined by REGA HIV subtyping tool (version 3.46, https://www.genomedetective.com/app/typingtool/hiv). Near full-length genomes (NFLG) of HIV-1 viruses were obtained by next generation sequencing method. Results: Sequences analysis of the pol gene revealed that CRF 01_AE (57.29%, 228/398) was the dominant subtype circulating in Suzhou City, followed by CRF 07_BC (17.34%, 69/398), subtype B (7.54%, 30/398), CRF 08_BC (6.53%, 26/398), CRF 67_01B (3.02%, 12/398) and CRF55_01B (2.51%, 10/398). The overall prevalence of drug-resistant mutations in ART failure HIV-infected individuals was 64.57% (257/398), including 45.48% (181/398) for nucleotide reverse transcriptase inhibitors (NRTIs) mutations, 63.32% (252/398) for non-nucleoside reverse transcriptase inhibitors (NNRTIs) mutations, and 3.02% (12/398) for protease inhibitors (PIs) mutations. Ten near full-length genomes (NFLG) of HIV-1 viruses were identified, including six recombinants of CRF 01_AE and subtype B, two recombinants of CRF 01_AE, subtype B and subtype C sequences, one recombinant of CRF 01_AE and subtype C and one recombinant of CRF 01_AE, subtype A1 and subtype C. Conclusions: The high prevalence of drug-resistant HIV-1 viruses was a serious challenge for HIV prevention and HIV-infected individuals’ treatment. Therapeutic regimens of ART failure HIV-infected individuals should be adjusted in time according to drug resistance test results. NFLG sequencing facilitates the identification of new HIV-1 recombinant strains.

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“…The main causes of death amongst these patients were tuberculosis and neurological infectious diseases, including cryptococcal meningitis. 70% and 48% of participants in the cross-sectional study had self-presented to the hospital in Homa Bay and Kinshasa respectively, and 25% and 23% had been hospitalised in the last 3 months indicating that patients cycle in and out of hospital and may not access timely referral when their health deteriorates (Bossard et al, 2021). Prior to hospitalisation, patients in Homa Bay had generally been receiving HIV care at a government health centre (49%) or hospital (30%), and in Kinshasa at the MSF-supported hospital OPD (38%) or a faithbased facility (23%).…”

Section: Study Contextmentioning

confidence: 99%

Slipping through the cracks: a qualitative study to explore pathways of HIV care and treatment amongst hospitalised patients with advanced HIV in Kenya and the Democratic Republic of the Congo

et al. 2021

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Advanced HIV causes substantial mortality in sub-Saharan Africa despite widespread antiretroviral therapy coverage. This paper explores pathways of care amongst hospitalised patients with advanced HIV in rural Kenya and urban Democratic Republic of the Congo, with a view to understanding their care-seeking trajectories and poor health outcomes. Thirty in-depth interviews were conducted with hospitalised patients with advanced HIV who had previously initiated first-line antiretroviral therapy, covering their experiences of living with HIV and careseeking. Interviews were audio-recorded, transcribed and translated before being coded inductively and analysed thematically. In both settings, participants' health journeys were defined by recurrent, severe symptoms and complex pathways of care before hospitalisation. Patients were often hospitalised after multiple failed attempts to obtain adequate care at health centres. Most participants managed their ill-health with limited support networks, lived in fragile economic situations and often experienced stress and other mental health concerns. Treatment-taking was sometimes undermined by strict messaging around adherence that was delivered in health facilities. These findings reveal a group of patients who had "slipped through the cracks" of health systems and social support structures, indicating both missed opportunities for timely management of advanced HIV and the need for interventions beyond hospital and clinical settings.

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High Prevalence of NRTI and NNRTI Drug Resistance Among ART-Experienced, Hospitalized Inpatients

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 6 publications

References 22 publications

Genetic characterization of HIV-1 viruses among cases with antiretroviral therapy failure in Suzhou City, China

Genetic characterization of HIV-1 viruses among cases with antiretroviral therapy failure in Suzhou City, China

Genetic characterization of HIV-1 viruses among antiretroviral therapy failure individuals in Suzhou City, China

Slipping through the cracks: a qualitative study to explore pathways of HIV care and treatment amongst hospitalised patients with advanced HIV in Kenya and the Democratic Republic of the Congo

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