Pre-treatment HIV drug resistance

With the progressive scale-up of antiretroviral therapy in Africa, pre-treatment drug resistance is increasing. People who have never been on treatment are found to harbour drug resistant HIV even before they start first-line antiretroviral therapy. In the PanAfrican Studies to Evaluate Resistance (PASER) cohort, a large prospective study in sub-Saharan Africa, pre-treatment drug resistance was not associated with new AIDS-related events or excess mortality but it did result in a 4-fold increase in switches to second-line regimens.

To our knowledge, this is the first study that provides direct evidence that rises in pre-treatment drug resistance levels as antiretroviral therapy is scaled up in Africa will drive a significant growth in the demand for second-line antiretroviral regimens in the region. This emerging threat to the effectiveness of national antiretroviral treatment programs will have major public health implications for budgets and program planning in the coming years. Our findings underscore the urgent need for widespread implementation of viral load monitoring and increased access to affordable second-line regimens to ensure durable HIV treatment success in sub-Saharan Africa.


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