Pan-resistant HIV-1: what's next?

Hamers, Raph L; Inzaule, Seth

doi:10.1016/s2666-5247(20)30058-6

Cited by 4 publications

(3 citation statements)

References 10 publications

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“…In 2017, mathematical modeling predicted that if left unchecked, excess levels of pretreatment HIVDR to the NNRTI drug class could directly lead to 890 000 AIDS deaths, 450 000 new infections, and 6.5 billion USD extra ART costs by 2030 in sub-Saharan Africa (SSA) [ 3 ]. Recently several cases of multi-drug class resistant HIV have been reported [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Exploring the mechanisms behind HIV drug resistance in sub-Saharan Africa: conceptual mapping of a complex adaptive system based on multi-disciplinary expert insights

et al. 2022

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Background HIV drug resistance (HIVDR) continues to threaten the effectiveness of worldwide antiretroviral therapy (ART). Emergence and transmission of HIVDR are driven by several interconnected factors. Though much has been done to uncover factors influencing HIVDR, overall interconnectedness between these factors remains unclear and African policy makers encounter difficulties setting priorities combating HIVDR. By viewing HIVDR as a complex adaptive system, through the eyes of multi-disciplinary HIVDR experts, we aimed to make a first attempt to linking different influencing factors and gaining a deeper understanding of the complexity of the system. Methods We designed a detailed systems map of factors influencing HIVDR based on semi-structured interviews with 15 international HIVDR experts from or with experience in sub-Saharan Africa, from different disciplinary backgrounds and affiliated with different types of institutions. The resulting detailed system map was conceptualized into three main HIVDR feedback loops and further strengthened with literature evidence. Results Factors influencing HIVDR in sub-Saharan Africa and their interactions were sorted in five categories: biology, individual, social context, healthcare system and ‘overarching’. We identified three causal loops cross-cutting these layers, which relate to three interconnected subsystems of mechanisms influencing HIVDR. The ‘adherence motivation’ subsystem concerns the interplay of factors influencing people living with HIV to alternate between adherence and non-adherence. The ‘healthcare burden’ subsystem is a reinforcing loop leading to an increase in HIVDR at local population level. The ‘ART overreliance’ subsystem is a balancing feedback loop leading to complacency among program managers when there is overreliance on ART with a perceived low risk to drug resistance. The three subsystems are interconnected at different levels. Conclusions Interconnectedness of the three subsystems underlines the need to act on the entire system of factors surrounding HIVDR in sub-Saharan Africa in order to target interventions and to prevent unwanted effects on other parts of the system. The three theories that emerged while studying HIVDR as a complex adaptive system form a starting point for further qualitative and quantitative investigation.

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Section: Introductionmentioning

confidence: 99%

Exploring the mechanisms behind HIV drug resistance in sub-Saharan Africa: conceptual mapping of a complex adaptive system based on multi-disciplinary expert insights

et al. 2022

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“…[39][40] In mid-2020 the world's fi rst case of pandrug resistance was reported in a patient infected with HIV-1 subtype B, who showed resistance to fi ve oral antiretroviral groups. [41] Among the limitations of working with FarmaVigiC is that it does not allow evaluation of treatment adherence, which is negatively related to toxicity. Toxicity infl uences treatment adherence because the more adverse reactions or signs of toxicity patients experience, the less likely they are to adhere to treatment regimens.…”

Section: Original Researchmentioning

confidence: 99%

Adverse Reactions to Antiretrovirals in Cuban Patients Living with HIV/AIDS

Morales-Pérez

2021

MEDICC Review

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INTRODUCTION Disease and deaths from HIV/AIDS have decreased since antiretroviral treatment was introduced in 1996. Since 2005, as treatment availability has increased worldwide, deaths from HIV/AIDS have declined 48%. As of November 2019, 26,952 cases have been reported in Cuba, of which 5159 (19.1%) are deceased. The country has experienced a reduction in mortality rates since 2002, when antiretroviral treatment became available. Although there are clearly benefi ts to treatment, it is important to understand antiretroviral safety profi les as their toxicity may lower treatment adherence. OBJECTIVE Describe adverse reactions attributable to antiretrovirals used in Cuban patients living with HIV/AIDS. METHODS I studied notifi cations of adverse reactions to antiretrovirals used in Cuban patients with HIV/AIDS from January 2003 to December 2017. The sample consisted of 352 notifi cations in the National Pharmacovigilance Database regarding adverse reactions attributed to antiretrovirals. The variables considered were sex, notifi cation year, antiretroviral drug, and number, type, frequency and severity of adverse reactions, whether or not they were preventable, and the reasons for categorizing them as they were. RESULTS Antiretrovirals reported an average adverse reaction rate of 2.1 per million population per year, representing 24.2% of adverse reactions produced by the antiviral drug group in that period. Adult males represented 75% (264/352) of patients who had adverse reactions to antiretrovirals. Most adverse reactions were in response to nevirapine (29.0%; 102/352) and zidovudine (26.7%; 94/352). The most frequent reactions were hypersensitivity (24.4%; 86/352), digestive disorders (15.9%; 56/352) and anemia (15.6%; 55/352). Reactions were common (62.5%; 220/352) and moderate in severity (70.4%; 248/352). Preventable reactions made up 52.6% (185/352) of adverse reactions. Of preventable reactions, 68.1% (126/185) were associated with drug interactions and 16.2% (30/185) with improper dosage or prescription errors.CONCLUSIONS Adverse reactions to antiretrovirals in Cuban patients are common and moderate in severity. The drug with the most notifi cations was nevirapine, and the most common adverse reaction was hypersensitivity. More than half of adverse reactions are considered preventable, and their main causes are prescription errors.

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“…One study of Kenyan women found highlevel tetracycline resistance in 96% of tested samples of N. gonorrhoeae [3], and numerous other common sexually transmitted infections have shown drug resistance across the globe, including syphilis, chlamydia, and trichomonas [4]. Of particular concern is the rise in drug-resistant human immunodeficiency virus (HIV), with the first strains of pan-resistant HIV now beginning to emerge [5].…”

mentioning

confidence: 99%