HIV drug resistance following a decade of the free antiretroviral therapy programme in India: A review

Karade, Santosh; Chaturbhuj, Devidas N.; Sen, Sourav; Joshi, Rajneesh Kumar; Kulkarni, Smita; Shankar, Subramanian; Gangakhedkar, Raman

doi:10.1016/j.ijid.2017.10.020

Cited by 18 publications

(12 citation statements)

References 46 publications

(33 reference statements)

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“…The increasing and preferential usage of TDF in the clinical practice [ 21 ], including in a context of a failing regimen, could be the primordial reason for the significant expansion of K65R as other studies show a higher prevalence of this mutation in patients failing ART treatment [ 15 , 52 , 53 , 54 , 55 ]. However, although an increasing trend was identified in a cohort from India [ 56 ], several studies report a decrease on K65R levels over the years in other countries [ 48 , 57 , 58 , 59 , 60 ]. Reinheimer and colleagues suggest that the decline on K65R prevalence rates is linked with the increasing usage of single tablet ART regimens and the inclusion of AZT on the used treatment regimen, which has been liked with K65R development suppression [ 61 ].…”

Section: Discussionmentioning

confidence: 99%

Nationwide Study of Drug Resistance Mutations in HIV-1 Infected Individuals under Antiretroviral Therapy in Brazil

Santos-Pereira

Triunfante

Araújo

et al. 2021

IJMS

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The success of antiretroviral treatment (ART) is threatened by the emergence of drug resistance mutations (DRM). Since Brazil presents the largest number of people living with HIV (PLWH) in South America we aimed at understanding the dynamics of DRM in this country. We analyzed a total of 20,226 HIV-1 sequences collected from PLWH undergoing ART between 2008–2017. Results show a mild decline of DRM over the years but an increase of the K65R reverse transcriptase mutation from 2.23% to 12.11%. This increase gradually occurred following alterations in the ART regimens replacing zidovudine (AZT) with tenofovir (TDF). PLWH harboring the K65R had significantly higher viral loads than those without this mutation (p < 0.001). Among the two most prevalent HIV-1 subtypes (B and C) there was a significant (p < 0.001) association of K65R with subtype C (11.26%) when compared with subtype B (9.27%). Nonetheless, evidence for K65R transmission in Brazil was found both for C and B subtypes. Additionally, artificial neural network-based immunoinformatic predictions suggest that K65R could enhance viral recognition by HLA-B27 that has relatively low prevalence in the Brazilian population. Overall, the results suggest that tenofovir-based regimens need to be carefully monitored particularly in settings with subtype C and specific HLA profiles.

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Section: Discussionmentioning

confidence: 99%

Nationwide Study of Drug Resistance Mutations in HIV-1 Infected Individuals under Antiretroviral Therapy in Brazil

Santos-Pereira

Triunfante

Araújo

et al. 2021

IJMS

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“…Failure to attain the required adherence level results in poorer prognosis, higher morbidity, mortality and the development of resistance to ART ( Iacob, Iacob & Jugulete, 2017 ; Nachega et al, 2011 ). Once resistance develops, it has dire consequences for individual PLWHA, family, community, healthcare providers and the healthcare system because treating ART resistant HIV strain requires second-line ART regimens, that are more expensive and have worse side effects ( Chauhan et al, 2019 ; Karade et al, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

Magnitude of non-adherence to antiretroviral therapy and associated factors among adult people living with HIV/AIDS in Benishangul-Gumuz Regional State, Ethiopia

Nigusso

Mavhandu-Mudzusi

2020

PeerJ

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Introduction Following global efforts to increase antiretroviral therapy (ART) access and coverage, Ethiopia has made significant achievement with a 6.3% annual decline in the HIV/AIDS incidence rate between 1990 and 2016. Such success depends not only on access to ART but also on attaining optimum treatment adherence. Emerging studies in Ethiopia has shown the increasing prevalence of poor adherence and lack of the desired viral suppression, but the extent and factors associated with non-adherence to ART are not well known, especially in the current study setup. In this study, we examined the magnitude and factors associated with treatment and non-adherence to ART among people living with HIV in Benishangul-Gumuz Regional State, northwest Ethiopia. Methods An institutional facility based cross-sectional descriptive study was carried out among adult people living with HIV/AIDS from mid-December 2016 to February 2017 with only 98.9% response rate. Sociodemographic factors (age, gender, marital status and residential area), economic factors (educational status, income, asset possession, employment status, dietary diversity, nutritional status and food security), and clinical characteristics (CD4 count, duration on ART and history of opportunistic infections) were explanatory variables. ART non-adherence was measured using a visual analogue scale (VAS). We used binary logistic regression and subsequent multivariate logistic regression analysis to determine the factors associated with ART non-adherence. Result Overall, 39.7% of the participants were found non-adherent to ART. Strong association was found between non-adherence to ART and young age below 25 years (AOR: 4.30, 95% CI [1.39–3.35]; p = 0.011), urban residential area (AOR: 2.78, CI [1.23–7.09], p = 0.043), lack of employment (AOR: 1.75, 95% CI [1.05–2.91], p = 0.032), food insecurity (AOR: 2.67, 95% CI [7.59–8.97]; p < 0.0001), malnutrition (AOR: 1.55, 95% CI [1.94–2.56]; p = 0.027) and opportunistic infections (AOR: 1.81, 95% CI [1.11–2.97]; p = 0.018). Conclusion The prevalence of non-adherence to ART in this study was high. Sociodemographic and economic factors such as young age of below 25 years, urban residential area, lack of employment, food insecurity, malnutrition and opportunistic infections were among the factors associated with non-adherence to ART.

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“…Responses are reported on a Likert-scale ranging from 0 "Not at all" to 3 "Most of the time" and reverse coded for negatively-framed items. The HADS-D has four scoring levels generated based on the sum of the responses: none [0-7], mild [8][9][10], moderate [11][12][13][14], and severe [15+]. One pilot study with PLH for the current study using this measure found high rates of depression but low rates of anxiety (26).…”

Section: Methodsmentioning

confidence: 99%

“…HIV requires lifelong self-management to remain adherent. Low adherence and interruptions can lead to viral rebound and negative consequences including transmission to others (8,9), failure of and potentially resistance to firstline medication (10), and HIV disease progression (4). Improving and sustaining ART adherence is essential to both prevention and treatment outcomes.…”

Section: Introductionmentioning

confidence: 99%

A pilot randomized controlled trial (RCT) of daily versus weekly interactive voice response calls to support adherence among antiretroviral treatment patients in India

Swendeman

Fehrenbacher

Roy

et al. 2020

mHealth

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Background: There are more than two million people living with HIV (PLH) in India, with more than 30% on antiretroviral treatment (ART) estimated to be non-adherent. This study aimed to (I) document adherence rates and related factors among ART patients in a large ART clinic in India, and (II) pilot test daily and weekly interactive voice response (IVR) calls to improve ART adherence and related outcomes.Methods: ART patients reporting missing at least one dose in prior 6 months (N=362) were enrolled and assessed via self-report and medical record review. Participants were randomized to one of two conditions:(I) twice-daily IVR call reminders with self-management support messaging, plus a weekly IVR adherence assessment; or (II) an attention control, with only weekly IVR adherence assessment. Participants completed study assessments at baseline, 2-, 4-, and 6-months with high retention (88% to 96%).Results: Intention-to-treat analyses found limited support for intervention effects for improving or maintaining ART adherence or CD4 counts between the two study arms over 6-months follow-up.Adherence increased significantly in the six months prior to baseline from about 65% to >95% with perfect adherence based on pill counts from medical records and consistent with patient self-report measures, which presented ceiling effects for detecting improvements in ART adherence in response to IVR intervention exposure. There was also limited support for intervention effects on secondary, self-management outcomes.Conclusions: High levels of adherence were sustained throughout the 6-month RCT. IVR regulation changes in India delayed study launch for 6 months, which likely allowed mobilization of improved adherence at the clinic, provider and patient levels in anticipation of the study launch. Therefore, ceiling effects limited inferences on intervention effects to improve adherence. Results suggest that clinic-level adherence monitoring may be sufficient to mobilize adherence improvements by providers and patients.

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HIV drug resistance following a decade of the free antiretroviral therapy programme in India: A review

Abstract: Although the overall burden of resistance against first-line ART agents remained steady over the study decade, periodic monitoring is essential. There is the need to develop an HIV-1 subtype C-specific resistance database in India.

Cited by 18 publications

References 46 publications

Nationwide Study of Drug Resistance Mutations in HIV-1 Infected Individuals under Antiretroviral Therapy in Brazil

Nationwide Study of Drug Resistance Mutations in HIV-1 Infected Individuals under Antiretroviral Therapy in Brazil

Magnitude of non-adherence to antiretroviral therapy and associated factors among adult people living with HIV/AIDS in Benishangul-Gumuz Regional State, Ethiopia

A pilot randomized controlled trial (RCT) of daily versus weekly interactive voice response calls to support adherence among antiretroviral treatment patients in India

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