Rates of Emergence of HIV Drug Resistance in Resource-Limited Settings: A Systematic Review

Antiviral Therapy - Tập 18 Số 1 - Trang 115-123 - 2013
Kathryn M. Stadeli1, Douglas D. Richman1,2
1University of California, San Diego, La Jolla, CA, USA
2VA San Diego Healthcare System, San Diego, CA, USA

Tóm tắt

BackgroundThe increasing availability of antiretroviral therapy (ART) has improved survival and quality of life for many infected with HIV, but can also engender drug resistance. This review summarizes the available information on drug resistance in adults in resource-limited settings.MethodsThe online databases PubMed and Google Scholar, pertinent conference abstracts and references from relevant articles were searched for publications available before November 2011. Data collected after ART rollout were reviewed.ResultsA total of 7 studies fulfilled the criteria for the analysis of acquired drug resistance and 22 fulfilled the criteria for the analysis of transmitted drug resistance (TDR). Acquired resistance was detected in 7.2% of patients on ART for 6–11 months, 11.1% at 12–23 months, 15.0% at 24-35 months, and 20.7% at ≥36 months. Multi-class drug resistance increased steadily with time on ART. The overall rate of TDR in all resource-limited countries studied was 6.6% (469/7,063). Patients in countries in which ART had been available for ≥5 years were 1.7x more likely to have TDR than those living in a country where ART had been available for <5 years ( P<0.001). The reported prevalence of TDR was 5.7% (233/4,069) in Africa, 7.6% (160/2,094) in Asia and 8.4% (76/900) in Brazil.ConclusionsThe emergence of drug resistance following access to ART in resource-limited settings resembles what was seen in resource-rich countries and highlights the need for virological monitoring for drug failure, drug resistance testing and alternative drug regimens that have proven beneficial in these resource-rich settings.

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Antiviral Therapy

Tập 18 Số 1

115-123

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