Perspective by Carlos del Rio, MD Professor of medicine, division of infectious diseases, Emory University School of Medicine on our recent CID manuscript on high-level transmitted resistance epidemic in Aruba.
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The major issue related to drug resistance in most of the world is that the most commonly used regimen contains efavirenz, and in many places (especially in Los Angeles), it is not available as a fixed dose combination, so people may not take their efavirenz. The findings in this study in Aruba show a large increase in the prevalence of K103N mutations from 2010 to 2015. But even the prevalence at 26% in 2010 is alarmingly high, so my question is, what did they do then? How did they act based on these data? The study sample is small and I suspect that all new diagnoses did not get baseline resistance testing (which is the case in most of the world). A major implication is that if we lose EFV, we are in trouble starting an EFV?containing regimen in most of the world where genotypic testing is not routinely available. Bottom line: we need ITI-based regimens available globally now.
Carlos del Rio, MD
Professor of medicine, division of infectious diseases, Emory University School of Medicine
Immediate past chair, HIV Medicine Association
Disclosure: del Rio reports being a member of the board of the HIV Medicine Association and International Antiviral Society-USA, and chair of the PEPFAR Scientific Advisory Board.