High rates of transmission of drug-resistant HIV in Aruba resulting in reduced susceptibility to the WHO recommended first-line regimen in nearly half of newly diagnosed HIV-infected patients
| Autor: | Karina Kelly, L. Marije Hofstra, Elena Sánchez Rivas, Rob Schuurman, Monique Nijhuis, Leonie E.A. Bank, Jaclyn De Kort, Tulio de Oliveira, Tania Mudrikova, Annemarie M. J. Wensing, Eduan Wilkinson |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
0301 basic medicine
Adult Male Microbiology (medical) medicine.medical_specialty Anti-HIV Agents Population Human immunodeficiency virus (HIV) HIV Infections Drug resistance Newly diagnosed medicine.disease_cause 03 medical and health sciences 0302 clinical medicine Acquired immunodeficiency syndrome (AIDS) Internal medicine Surveys and Questionnaires Drug Resistance Viral medicine Major Article Journal Article Humans 030212 general & internal medicine education education.field_of_study therapy drug resistance business.industry Transmission (medicine) transmission HIV virus diseases Middle Aged medicine.disease Virology Regimen 030104 developmental biology Infectious Diseases Caribbean Region HIV-1 surveillance Female business HIV drug resistance |
| Zdroj: | Clinical Infectious Diseases, 64(8), 1092. Oxford University Press Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America |
| ISSN: | 1058-4838 |
| Popis: | Summary The prevalence of resistant HIV in Aruba has increased to alarming levels, compromising the WHO-recommended first-line regimen. As adequate surveillance as advocated by the WHO is limited, the Caribbean region could face an unidentified rise of NNRTI-resistant HIV. Background. In Western countries emergence of human immunodeficiency virus (HIV) drug resistance has tremendously decreased, and transmission of drug resistance has merely stabilized in recent years. However, in many endemic settings with limited resources rates of emerging and transmitted drug resistance are not regularly assessed. Methods. We performed a survey including all HIV-infected individuals who received resistance testing in 2010–2015 in Aruba, a highly endemic HIV area in the Caribbean. Transmitted HIV drug resistance was determined using World Health Organization (WHO) criteria. Transmission dynamics were investigated using phylogenetic analyses. In a subset, baseline samples were re-analyzed using next generation sequencing (NGS). Results. Baseline resistance testing was performed in 104 newly diagnosed untreated individuals (54% of all newly diagnosed individuals in 2010–2015): 86% were men, 39% were foreign-born, and 22% had AIDS at diagnosis. And 33% (95% CI: 24–42%) was infected with a drug-resistant HIV variant. The prevalence of resistance to non-nucleoside reverse transcriptase inhibitors (NNRTIs) reached 45% (95% CI: 27–64%) in 2015, all based on the prevalence of mutation K103N. NGS did not demonstrate additional minority K103N-variants compared to routine resistance testing. K103N-harboring strains were introduced into the therapy-unexposed population via at least 6 independent transmissions epidemiologically linked to the surrounding countries. Virological failure of the WHO-recommended first-line NNRTI-based regimen was higher in the presence of K103N. Conclusions. The prevalence of resistant HIV in Aruba has increased to alarming levels, compromising the WHO-recommended first-line regimen. As adequate surveillance as advocated by the WHO is limited, the Caribbean region could face an unidentified rise of NNRTI-resistant HIV. |
| Databáze: | OpenAIRE |
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