High rates of transmitted NNRTI resistance among persons with acute HIV infection in Malawi: implications for first-line dolutegravir scale-up.

AIDS Research and Therapy
Sarah E RutsteinMina C Hosseinipour

Abstract

High rates of non-nucleoside reverse transcriptase inhibitors (NNRTI) resistance was a key consideration in the WHO policies transitioning first-line regimens to include integrase inhibitors (dolutegravir [DTG]). However, recent data suggests a relationship between DTG and neural tube defects among women exposed during conception, giving providers and policymakers pause regarding the planned regimen changes. We examined HIV drug resistance among a cohort of 46 acutely infected persons in Malawi. Our data demonstrates high levels of transmitted resistance, 11% using standard resistance surveillance mutations and 20% when additional NNRTI polymorphisms that may affect treatment response are included. High resistance rates in this treatment-naïve patient population reinforces the critical nature of DTG-based options in the context of public-health driven treatment programs.

References

Nov 1, 2011·The Lancet Infectious Diseases·Raph L HamersUNKNOWN PharmAccess African Studies to Evaluate Resistance (PASER) Investigators
Nov 8, 2013·The New England Journal of Medicine·Sharon L WalmsleyUNKNOWN SINGLE Investigators
Feb 15, 2015·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Rami KantorUNKNOWN AIDS Clinical Trials Group (ACTG) A5175 Study Team
Oct 25, 2016·The Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine·UNKNOWN Society for Adolescent Health and Medicine
Feb 10, 2017·Health Promotion International·UNKNOWN World Health Organization
Nov 28, 2017·The Lancet. HIV·Andrew N PhillipsUNKNOWN Working Group on Modelling Potential Responses to High Levels of Pre-ART Drug Resistance in Sub-Saharan Africa
Jun 6, 2018·Sexually Transmitted Diseases·Katherine B RucinskiAudrey E Pettifor
Jul 25, 2018·The New England Journal of Medicine·Rebecca ZashRoger L Shapiro

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NCT01450189

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