05 Jun Worldwide trends in Transmitted HIV-1 Dr

The global scale-up of antiretroviral therapy (ART) has reduced AIDS deaths and HIV incidence, but drug resistance is threatening these advances. This meta-analysis combined data from 50,870 patients in 287 studies between 2000 and 2013. It found that the average overall prevalence of transmitted drug resistance (TDR) ranged from 2.8% in sub-Saharan Africa to 11.5% in North America. In Africa, the odds (chance) of TDR increased 1.09-fold per year following the start of ART scale-up. This was resistance associated with nucleoside reverse transcriptase inhibitors (NRTIs) and non-NRTIs. In low-income south/southeast Asia, the odds of TDR remained unchanged following ART scale-up. In Latin America/Caribbean, North America, Europe, and upper-income Asian countries, the odds of TDR increased 1.10-fold per year since 1995, mainly due to non-NRTI resistance. The finding that most TDR strains in Africa and Asia arose independently suggests that improved patient adherence and the use of ART regimens to which HIV rarely develops resistance could reduce the generation of new resistant HIV strains. In addition, only a few NNRTI-resistance mutations were responsible for most cases of TDR. This suggests that an inexpensive assay that detects these mutations would be useful for pre-therapy screening in areas with high TDR levels.

Click here for the article – Plos Medecine