Trends of transmitted drug resistance of HIV-1 and its impact on treatment response to first-line antiretroviral therapy in Taiwan

Lai, Chung-Sheng; Hung, Chien‐Ching; Chen, Mao-Yuan; Sun, Hsin‐Yun; Lu, Ching-Lan; Tseng, Yu-Tzu; Chang, Shu-Fang; Su, Yi‐Ching; Liu, Wen-Chun; Hsieh, Chia Chien; Wu, Pei‐Ying; Chang, Sui‐Yuan; Chang, Shan‐Chwen

doi:10.1093/jac/dkr601

Cited by 26 publications

(25 citation statements)

References 36 publications

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“…The overall TDR rate was higher than a previous study performed in Northern Taiwan covering the period from 2000 to 2010, which reported an antiretroviral resistance rate of 8%. 9 This may be due to the different study populations enrolled. The study performed in Northern Taiwan enrolled patients infected with HIV and who received HIV care at the National Taiwan University Hospital.…”

Section: Discussionmentioning

confidence: 99%

“…9 The difference in rates of resistance from the previously-mentioned studies is probably due to the differences in stages of infection in the patients at the time of enrollment and different HIV transmission routes in these studies. There are, however, no data on the prevalence of local HIV drug resistance in Southern Taiwan, especially in those receiving VCT.…”

Section: Introductionmentioning

confidence: 92%

“…Lai et al 9 reported the epidemiology and impact of HIVtransmitted drug resistance in Northern Taiwan; however, the prevalence and pattern of HIV transmitted drug resistance in Southern Taiwan remains uncertain. Because drugresistant HIV strains may graduate stepwise to back-mutate certain drug-resistance mutations in vivo in the absence of ongoing drug selection pressure, 10 patients who are diagnosed with HIV infection from VCT are more likely to be in an early stage of HIV infection, and the mutation pattern from them is more likely to reflect the true drug resistance pattern.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Prevalence and associated factors for HIV-1 transmitted drug resistance in voluntary clients for counseling and testing in Southern Taiwan

Weng

Tsai

Lee

et al. 2016

Journal of Microbiology, Immunology and Infection

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Prevalence and associated factors for HIV-1 transmitted drug resistance in voluntary clients for counseling and testing in Southern Taiwan

Weng

Tsai

Lee

et al. 2016

Journal of Microbiology, Immunology and Infection

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“…Genotypic resistance assays were neither offered free-of-charge or routinely determined before cART initiation, although surveillance data suggested that the prevalence of transmitted drug resistance of HIV-1 to at least one antiretroviral was in the range of 10–15%; instead, the assays were performed at Taiwan CDC or a few designated hospitals for patients with virological failure and PVL >1000 copies/mL [12–14]. The national HIV treatment guidelines had increased the CD4 cell count threshold for cART initiation from 350 to 500 cells/mm 3 in September 2013 [11], which was further revised to treat all HIV-positive patients irrespective of CD4 cell count in June 2016.…”

Section: Methodsmentioning

confidence: 99%

Trends and outcomes of late initiation of combination antiretroviral therapy driven by late presentation among HIV-positive Taiwanese patients in the era of treatment scale-up

Lin

Cheng

et al. 2017

PLoS ONE

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ObjectivesThe international and national HIV treatment guidelines in 2016 have focused on scaling up access to combination antiretroviral therapy (cART). We aimed to assess the trends and treatment outcomes of late cART initiation in Taiwan.MethodsBetween June 2012 and May 2016, we retrospectively included antiretroviral-naive HIV-positive adults who initiated cART. Late initiation was defined as when cART was initiated in patients with a CD4 count <200 cells/mm3 or having experienced AIDS-defining illnesses. The treatment outcomes were assessed up to 6 months after starting cART.ResultsWe included 3655 HIV-positive patients, and the majority of the patients were male (95.4%) with a median age of 31 years and initiated non-nucleoside reverse-transcriptase inhibitor-containing regimens (87.0%). The median CD4 count at cART initiation increased from 207 cells/mm3 in 2012 to 298 cells/mm3 in 2016, and the overall proportion of late cART initiation decreased from 49.1% in 2012 to 29.0% in 2016 (P for trend <0.001). Late cART initiation mainly resulted from late presentation for HIV care and was associated with older age (per 1-year increase, adjusted odds ratio [AOR], 1.05; 95% CI, 1.04–1.06), HBsAg seropositivity (AOR, 1.31; 95% CI, 1.04–1.64), HIV care in central and southern Taiwan, initiating cART in earlier year, non-intravenous drug users (AOR, 1.96; 95% CI, 1.33–2.86), and negative hepatitis C serostatus (AOR, 1.47; 95% CI, 1.04–2.08). Compared with non-late initiators, late initiators had a higher rate of all-cause mortality (1.7% vs. 0.3%) and regimen modification due to virological failure (7.1% vs. 2.6%). The predicting factors of all-cause mortality were late cART initiation (adjusted hazard ratio [AHR], 5.40; 95% CI, 2.14–13.65) and older age (AHR, 1.06; 95% CI, 1.03–1.10).ConclusionsWhile the proportion of late cART initiation decreased over time in Taiwan, late initiation remained in a substantial proportion of HIV-positive patients. The late initiators had higher risk for poor outcomes. The need for strategies to earlier detection of HIV infection and expediting cART initiation should be highlighted, especially among the older population.

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“…The GSS has been described as a valuable tool in predicting virologic treatment outcomes for the salvage therapy, consequently preserving future treatment options [Maggiolo et al, 2007; Zazzi et al, 2009]. Generally, patients with GSS ≥ 2.5 achieve good clinical outcomes more frequently than those patients with a low score [Castor et al, 2009; Lai et al, 2012]. GSS was evaluated in order to understand better the virologic failures observed in the analyzed cohort.…”

Section: Discussionmentioning

confidence: 99%

Monitoring the emergence of resistance mutations in patients infected with HIV‐1 under salvage therapy with raltegravir in Rio de Janeiro, Brazil: A follow‐up study

Passaes

Guimarães

Cardoso

et al. 2012

Journal of Medical Virology

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The present study describes a follow-up of a prospective and observational cohort of patients infected with HIV-1 and treated with raltegravir for salvage therapy in Brazil. Two groups of patients were analyzed: switching from T20 to RAL (Group 1, n = 9) and salvage therapy containing RAL (Group 2, n = 10). Blood samples were drawn for CD4(+) T-cell counts and HIV-1 viral load determinations. Protease, reverse transcriptase, and integrase genotyping were performed at baseline and at the time of virologic failure. CD4(+) T-cells increased at 6 and 12 months in both groups; HIV-1 viral load was continuously suppressed for Group 1, and for Group 2 it significantly decreased after starting a RAL-containing regimen. Three out of 10 patients from Group 2 could not suppress HIV-1 viral load. The mutations Q148H + G140S were observed for two patients and for the third patient only mutations to PR/RT inhibitors were detected. The genotypic sensitivity score (GSS) was analyzed for all patients of Group 2 and both patients who developed resistance to raltegravir presented a GSS < 2.0 for the RAL-containing scheme, which could be associated to the lack of effectiveness of the proposed scheme. The present study describes, for the first time in Brazil, the close follow-up of a series of patients using a raltegravir-containing HAART, showing the safety of the enfuvirtide switch to RAL and the effectiveness of a therapeutic regimen with RAL in promoting immune reconstitution and suppressing HIV replication, as well as documenting the occurrence of resistance to integrase inhibitors in the country.

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Trends of transmitted drug resistance of HIV-1 and its impact on treatment response to first-line antiretroviral therapy in Taiwan

Cited by 26 publications

References 36 publications

Prevalence and associated factors for HIV-1 transmitted drug resistance in voluntary clients for counseling and testing in Southern Taiwan

Prevalence and associated factors for HIV-1 transmitted drug resistance in voluntary clients for counseling and testing in Southern Taiwan

Trends and outcomes of late initiation of combination antiretroviral therapy driven by late presentation among HIV-positive Taiwanese patients in the era of treatment scale-up

Monitoring the emergence of resistance mutations in patients infected with HIV‐1 under salvage therapy with raltegravir in Rio de Janeiro, Brazil: A follow‐up study

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