Presence of HIV drug resistance in antiretroviral therapy-naive and -experienced patients from Papua New Guinea

Gare, Janet; Ryan, Claire; David, Matthew; Timbi, Diana; Kaima, Petronia; Kombati, Zure; Imara, Ulato; Kelly‐Hanku, Angela; Siba, Peter; Crowe, Suzanne; Hearps, Anna C.

doi:10.1093/jac/dku089

Cited by 10 publications

(12 citation statements)

References 15 publications

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“…However, vigilance must remain as there is already evidence of drug resistance within the same study cohort. [ 20 ]…”

Section: Discussionmentioning

confidence: 99%

“…Ten mL of whole blood was also drawn for drug resistance and viral load testing, which were performed as described elsewhere. [ 20 , 21 ]…”

Section: Methodsmentioning

confidence: 99%

“…The current paper draws from a larger study on HIV drug resistance in PNG [ 20 ] and its aims to measure ART adherence in PLHIV. We report the levels of ART adherence of PLHIV who have been taking ART using self-reporting and pill count, identified barriers to adherence, and measured the virological outcomes of PLHIV taking ART.…”

Section: Introductionmentioning

confidence: 99%

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Factors Influencing Antiretroviral Adherence and Virological Outcomes in People Living with HIV in the Highlands of Papua New Guinea

et al. 2015

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Adherence to antiretroviral therapy (ART) is paramount for virological suppression and positive treatment outcomes. ART has been rapidly scaled up in Papua New Guinea (PNG) in recent years, however clinical monitoring of HIV+ individuals on ART is limited. A cross-sectional study was conducted at two major sexual health clinics in high HIV prevalence provinces in the Highlands Region of PNG to assess ART adherence, factors affecting adherence and the relationship between ART adherence and virological outcomes. Ninety-five HIV+ individuals were recruited and administered a questionnaire to gather demographic and ART adherence information whilst clinical data and pill counts were extracted from patient charts and blood was collected for viral load testing. Bivariate analysis was performed to identify independent predictors of ART adherence. Fourteen percent (n = 12) of participants showed evidence of virological failure. Although the majority of participants self-reported excellent ART adherence in the last seven days (78.9%, 75/91), pill count measurements indicated only 40% (34/84) with >95% adherence in the last month. Taking other medications while on ART (p = 0.01) and taking ART for ≥1 year (p = 0.037) were positively associated with adherence by self-report and pill count, respectively. Participants who had never heard of drug resistance were more likely to show virological failure (p = 0.033). Misconception on routes of HIV transmission still persists in the studied population. These findings indicate that non-adherence to ART is high in this region of PNG and continued education and strategies to improve adherence are required to ensure the efficacy of ART and prevent HIV drug resistance.

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“…However, vigilance must remain as there is already evidence of drug resistance within the same study cohort. [ 20 ]…”

Section: Discussionmentioning

confidence: 99%

“…Ten mL of whole blood was also drawn for drug resistance and viral load testing, which were performed as described elsewhere. [ 20 , 21 ]…”

Section: Methodsmentioning

confidence: 99%

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Factors Influencing Antiretroviral Adherence and Virological Outcomes in People Living with HIV in the Highlands of Papua New Guinea

et al. 2015

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“…The most dramatic of those changes was the advent of treatment drugs. Initially very expensive, the price soon fell and international, national and interest group pressures resulted in the introduction of a treatment program to PNG in 2004 [10].…”

Section: Introductionmentioning

confidence: 99%

“…There has been little sentinel surveillance in recent years, the quality of laboratory testing is low, drug stockouts are common, and there are high rates of loss to follow-up in the drug treatment program. Drug resistance is an emerging problem [10]. The list goes on.…”

Section: Introductionmentioning

confidence: 99%

What's happening with HIV in Papua New Guinea?

Heywood

2015

Preprint

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Introduction: In the 30 years since its identification in Papua New Guinea the response to HIV and its subsequent spread has waxed and waned and taken new directions as the social and biomedical environment changed. More than 30 years later the surveillance system continues to falter and there has still not been a national survey on which estimates can be based. Absent a functioning surveillance system, PNG ‘’estimates’’ the size of the epidemic from time to time based on mathematical models of the epidemic. This has resulted in widely varying estimates and confusion about the course of the epidemic. After appearance of the virus PNG struggled to design and implement an effective response. A new government at the end to the 1990s saw a strengthened response and formation of a National AIDS Council (NAC) located, eventually, in the Office of the Prime Minister. Around the same time PNG commenced a process of decentralizing government services to provinces and districts. DOH was expected to continue to provide services even though overall control now was with the NAC and responsibility for services was decentralized.Discussion: PNG is now reliant on mathematical models to estimate the course of the epidemic. Even though the most recent results indicate a fall in incidence since 2005, two recent reviews indicate that programs have not been effective at most levels and that the dual architecture of the government response has failed to adjust to the decentralization of government activities. Thus we now have the situation where models indicate lower prevalence than originally projected even though interventions are apparently ineffective and we have no reliable independent data to indicate why? There are two lessons from the PNG experience. First, the importance of establishing an effective HIV surveillance system. And second, realization that the NAC approach, originally seen as a panacea by donors and agencies, has not worked in PNG. The critical thing now is to return control of the HIV/AIDS program to the DOH on the condition that, except for surveillance and setting standards, it decentralizes the program to provinces and districts.

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Human Genetic Variation and HIV/AIDS in Papua New Guinea: Time to Connect the Dots

Mehlotra

2018

Curr HIV/AIDS Rep

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PNG, a country in Oceania, has a high prevalence of HIV and many sexually transmitted infections. While limited data is available from this country regarding the distribution of human genetic polymorphisms known to influence clinical outcomes of HIV/AIDS, genetic association studies are lacking. Our studies, in the past decade, have revealed that polymorphisms in chemokine receptor-ligand (CCR2-CCR5, CXCL12), innate immune (Toll-like receptor, β-defensin), and antiretroviral drug-metabolism enzyme (CYP2B6, UGT2B7) genes are prevalent in PNG. Although our results need to be validated in further studies, it is urgent to pursue large-scale, comprehensive genetic association studies that include these as well as additional genetic polymorphisms.

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Presence of HIV drug resistance in antiretroviral therapy-naive and -experienced patients from Papua New Guinea

Cited by 10 publications

References 15 publications

Factors Influencing Antiretroviral Adherence and Virological Outcomes in People Living with HIV in the Highlands of Papua New Guinea

Factors Influencing Antiretroviral Adherence and Virological Outcomes in People Living with HIV in the Highlands of Papua New Guinea

What's happening with HIV in Papua New Guinea?

Human Genetic Variation and HIV/AIDS in Papua New Guinea: Time to Connect the Dots

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