HIV-1 drug resistance before initiation or re-initiation of first-line antiretroviral therapy in low-income and middle-income countries: a systematic review and meta-regression analysis. Lancet Infectious Diseases, : http://dx.doi.org/10.1016/S1473-3099(17)30702-8 (2017).

Publication Latest Publications

Title: HIV-1 drug resistance before initiation or re-initiation of first-line antiretroviral therapy in low-income and middle-income countries: a systematic review and meta-regression analysis
Authors: Ravindra K Gupta, John Gregson, Neil Parkin, Hiwot Haile-Selassie, Amilcar Tanuri, Liliana Andrade Forero, Pontiano Kaleebu, Christine Watera, Avelin Aghokeng, Nicholus Mutenda, Janet Dzangare, San Hone, Zaw Zaw Hang, Judith Garcia, Zully Garcia, Paola Marchorro, Enrique Beteta, Amalia Giron, Raph Hamers, Seth Inzaule, Lisa M Frenkel, Michael H Chung, de Oliveira T, Deenan Pillay, Kogie Naidoo, Ayesha Kharsany, Ruthiran Kugathasan, Teresa Cutino, Gillian Hunt, Santiago Avila Rios, Meg Doherty, Michael R Jordan, Silvia Bertagnolio.
Journal: Lancet Infectious Diseases,:http://dx.doi.org/10.1016/S1473-3099(17)30702-8 (2017)

Journal Impact Factor (I.F.): 16.144
Number of citations (Google Scholar): 1

Abstract

Background:

Pretreatment drug resistance in people initiating or re-initiating antiretroviral therapy (ART) containing non-nucleoside reverse transcriptase inhibitors (NNRTIs) might compromise HIV control in low-income and middleincome countries (LMICs). We aimed to assess the scale of this problem and whether it is associated with the intiation or re-initiation of ART in people who have had previous exposure to antiretroviral drugs.

Methods:

This study was a systematic review and meta-regression analysis. We assessed regional prevalence of pretreatment drug resistance and risk of pretreatment drug resistance in people initiating ART who reported previous ART exposure. We systematically screened publications and unpublished datasets for pretreatment drug-resistance data in individuals in LMICs initiating or re-initiating first-line ART from LMICs. We searched for studies in PubMed and Embase and conference abstracts and presentations from the Conference on Retroviruses and Opportunistic Infections, the International AIDS Society Conference, and the International Drug Resistance Workshop for the period Jan 1, 2001, to Dec 31, 2016. To assess the prevalence of drug resistance within a specified region at any specific timepoint, we extracted study level data and pooled prevalence estimates within the region using an empty logistic regression model with a random effect at the study level. We used random effects meta-regression to relate sampling year to prevalence of pretreatment drug resistance within geographical regions.

Findings:

We identified 358 datasets that contributed data to our analyses, representing 56 044 adults in 63 countries. Prevalence estimates of pretreatment NNRTI resistance in 2016 were 11.0% (7.5-15.9) in southern Africa, 10.1% (5.1-19.4) in eastern Africa, 7.2% (2.9-16.5) in western and central Africa, and 9.4% (6.6-13.2) in Latin America and the Caribbean. There were substantial increases in pretreatment NNRTI resistance per year in all regions. The yearly increases in the odds of pretreatment drug resistance were 23% (95% CI 16-29) in southern Africa, 17% (5-30) in eastern Africa, 17% (6-29) in western and central Africa, 11% (5-18) in Latin America and the Caribbean, and 11% (2-20) in Asia. Estimated increases in the absolute prevalence of pretreatment drug resistance between 2015 and 2016 ranged from 0.3% in Asia to 1.8% in southern Africa.

Interpretation:

Pretreatment drug resistance is increasing at substantial rate in LMICs, especially in sub-Saharan Africa. In 2016, the prevalence of pretreatment NNRTI resistance was near WHO-s 10% threshold for changing firstline ART in southern and eastern Africa and Latin America, underscoring the need for routine national HIV drugresistance surveillance and review of national policies for first-line ART regimen composition.

Download: Full text paper

Citation: Ravindra K Gupta, John Gregson, Neil Parkin, Hiwot Haile-Selassie, Amilcar Tanuri, Liliana Andrade Forero, Pontiano Kaleebu, Christine Watera, Avelin Aghokeng, Nicholus Mutenda, Janet Dzangare, San Hone, Zaw Zaw Hang, Judith Garcia, Zully Garcia, Paola Marchorro, Enrique Beteta, Amalia Giron, Raph Hamers, Seth Inzaule, Lisa M Frenkel, Michael H Chung, de Oliveira T, Deenan Pillay, Kogie Naidoo, Ayesha Kharsany, Ruthiran Kugathasan, Teresa Cutino, Gillian Hunt, Santiago Avila Rios, Meg Doherty, Michael R Jordan, Silvia Bertagnolio. HIV-1 drug resistance before initiation or re-initiation of first-line antiretroviral therapy in low-income and middle-income countries: a systematic review and meta-regression analysis Lancet Infectious Diseases,:http://dx.doi.org/10.1016/S1473-3099(17)30702-8 (2017).

Printed and Online Media Coverage

KRISP News

Rising levels of HIV drug resistance

KRISP News - 2017-12-01

HIV drug resistance is approaching and exceeding 10% in people living with HIV who are about to initiate or reinitiate first-line antiretroviral therapy, according to the largest meta-analysis to date on HIV drug resistance.


KRISP News

HIV drug resistance is on the rise, notes research

KRISP News - 2017-12-01

Drug resistance in HIV is rising to more than 10% in people with HIV who are preparing to start (or re-start) first-line antiretroviral therapy, according to a recently published meta-analysis.



HIV-1 drug resistance before initiation or re-initiation of first-line antiretroviral therapy in low-income and middle-income countries: a systematic review and meta-regression analysis
Journal: Lancet Infectious Diseases (2017)

Universal test and treat and the HIV epidemic in rural South Africa: a phase 4, open-label, community cluster randomised trial
Journal: Lancet HIV (2017)

Longitudinal trends in the prevalence of detectable HIV viremia: Population-based evidence from rural KwaZulu-Natal, South Africa
Journal: Clin Infect Dis. (2017)
All publications...


Page design updated by Tulio de Oliveira, 2013