Few mutations implicated in transmission of drug-resistant HIV
A small number of mutations are responsible for most cases of drug-resistant HIV transmission worldwide, according to recent findings.
“This is to our knowledge the first individual-patient-level meta-analysis of [transmitted drug resistance (TDR)] in HIV-1 infected, ART-naive populations,” Soo-Yon Rhee, MS, and colleagues at Stanford University wrote in PLoS Medicine.
The researchers analyzed HIV sequencing data for 50,870 people from 111 countries who were enrolled in 287 studies. They sought any of the 93 mutations known to be indicators of drug resistance.
The median TDR prevalence in sub-Saharan Africa was 2.8%, and in south/southeast Asia, it was 2.9%, the researchers wrote. Median TDR prevalence was 5.6% in upper-income Asian countries, 9.4% in Europe and 11.5% in North America. Since ART scale-up began in sub-Saharan Africa, there has been an annual 1.09-fold increase in the odds of TDR resulting from a rise in non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance.
In sub-Saharan Africa and south/southeast Asia, 95% of the viruses tested were not closely related.
“ART regimens with a high genetic barrier to resistance combined with improved patient adherence may mitigate TDR increases by reducing the generation of new ART-resistant strains,” the researchers wrote.
Since only a few NNRTI mutations accounted for most of transmission of drug-resistant HIV, a simple and inexpensive point-mutation test to detect these mutations may be a good prescreening tool in high-TDR areas, according to the investigators.
“In the context of a public health approach to ART, a reliable point-of-care genotypic resistance test could identify which patients should receive standard first-line therapy and which should receive a protease-inhibitor-containing regimen,” the researchers wrote. – by Colleen Owens
Disclosure: Rhee reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.