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HIV Treatment Scale-up in Africa: The Impact of Drug Resistance

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HIV/AIDS Treatment in Resource Poor Countries

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Abstract

The availability of antiretroviral therapy (ART) to individuals infected with HIV in many African countries has greatly increased since 2004, as result of coordinated efforts of funding agencies and individual governments in rolling out HIV care and treatment. As the numbers of individuals receiving ART rises, the long-term clinical outcomes of ART among patients on treatment, needs to be further understood. In many resource-limited countries, the data on patterns of HIV resistance to antiretroviral drugs and the effect of HIV subtype diversity on resistance remains limited. Patients’ social economic situations and deficiencies in health systems could promote non-adherence that facilitates the development of drug resistance. Here we explore available data on HIV-1 resistance to ART in Africa, in relation to the drug regimens used, HIV-1 subtype diversity and its implication on drug resistance. We specifically examine reported HIV resistance associated with treatment, transmitted resistance, and prevention of mother-to-child transmission programs. Finally, we identify specific measures both in terms of research and public health efforts to contain and prevent drug resistance development in patients on treatment.

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References

  1. UNAIDS (2010) Botswana: progress towards universal access and the declaration of commitment on HIV/AIDS. UNAIDS, Geneva

    Google Scholar 

  2. UNAIDS (2010) AIDS epidemic update. http://data.unaids.org/pub/Report/2009/JCI700EpiUpdate2009en.pdf

  3. UNAIDS/WHO (2008) Epidemiological fact sheets on HIV and AIDS, 2008 updates. UNAIDS, Geneva

    Google Scholar 

  4. Kanki P (2009) The challenge and response in Nigeria. In: Kanki P, Marlink R (eds) A line drawn in the sand: responses to the AIDS treatment crisis in Africa. Harvard Center for Population and Development Studies, Cambridge, MA, pp 63–91

    Google Scholar 

  5. USAID (2008) Africa region: HIV/AIDS health profile. USAID

    Google Scholar 

  6. TACAID (2008) Tanzania: Country progress report. UNAIDS, Geneva

    Google Scholar 

  7. Gilks CF, Crowley S, Ekpini R, Gove S, Perriens J, Souteyrand Y et al (2006) The WHO public-health approach to antiretroviral treatment against HIV in resource-limited settings. Lancet 368:505–510

    Article  PubMed  Google Scholar 

  8. WHO (2006) Antiviral therapy for HIV infection in adults and adolescents: recommendations for public health approach. World Health Organization, Geneva

    Google Scholar 

  9. WHO (2010) Antiretroviral therapy for HIV infection in adults and adolescents, recommendations for a public health approach

    Google Scholar 

  10. Preston BD (1997) Reverse transcriptase fidelity and HIV-1 variation. Science 275:228–229, author reply 230–221

    Article  PubMed  CAS  Google Scholar 

  11. Roberts JD, Bebenek K, Kunkel TA (1988) The accuracy of reverse transcriptase from HIV-1. Science 242:1171–1173

    Article  PubMed  CAS  Google Scholar 

  12. Ho DD, Neumann AU, Perelson AS, Chen W, Leonard JM, Markowitz M (1995) Rapid turnover of plasma virions and CD4 lymphocytes in HIV-1 infection. Nature 373:123–126

    Article  PubMed  CAS  Google Scholar 

  13. Wei X, Ghosh SK, Taylor ME, Johnson VA, Emini EA, Deutsch P et al (1995) Viral dynamics in human immunodeficiency virus type 1 infection. Nature 373:117–122

    Article  PubMed  CAS  Google Scholar 

  14. Johnson VA, Brun-Vezinet F, Clotet B, Gunthard HF, Kuritzkes DR, Pillay D et al (2007) Update of the drug resistance mutations in HIV-1: 2007. Top HIV Med 15:119–125

    PubMed  Google Scholar 

  15. Bisson GP, Frank I, Gross R, Lo Re V 3rd, Strom JB, Wang X et al (2006) Out-of-pocket costs of HAART limit HIV treatment responses in Botswana’s private sector. AIDS 20:1333–1336

    Article  PubMed  Google Scholar 

  16. Cohen GM (2007) Access to diagnostics in support of HIV/AIDS and tuberculosis treatment in developing countries. AIDS 21(suppl 4):S81–S87

    Article  PubMed  Google Scholar 

  17. Nugent R, Pickett J, Back E (2008) Drug resistance as global health policy priority. Center for Global Development, Washington, DC

    Google Scholar 

  18. WHO (2006) The World Health report, 2006. World Health Organization, Geneva

    Google Scholar 

  19. Breen RA, Swaden L, Ballinger J, Lipman MC (2006) Tuberculosis and HIV co-infection: a practical therapeutic approach. Drugs 66:2299–2308

    Article  PubMed  CAS  Google Scholar 

  20. Fonjungo PN, Dash BC, Mpoudi EN, Torimiro JN, Alemnji GA, Eno LT et al (2000) Molecular screening for HIV-1 group N and simian immunodeficiency virus cpz-like virus infections in Cameroon. AIDS 14:750–752

    Article  PubMed  CAS  Google Scholar 

  21. Jaffe HW, Schochetman G (1998) Group O human immunodeficiency virus-1 infections. Infect Dis Clin North Am 12:39–46

    Article  PubMed  CAS  Google Scholar 

  22. Grobler J, Gray CM, Rademeyer C, Seoighe C, Ramjee G, Karim SA et al (2004) Incidence of HIV-1 dual infection and its association with increased viral load set point in a cohort of HIV-1 subtype C-infected female sex workers. J Infect Dis 190:1355–1359

    Article  PubMed  Google Scholar 

  23. Hu DJ, Subbarao S, Vanichseni S, Mock PA, Ramos A, Nguyen L et al (2005) Frequency of HIV-1 dual subtype infections, including intersubtype superinfections, among injection drug users in Bangkok, Thailand. AIDS 19:303–308

    PubMed  Google Scholar 

  24. Hemelaar J, Gouws E, Ghys PD, Osmanov S (2006) Global and regional distribution of HIV-1 genetic subtypes and recombinants in 2004. AIDS 20:W13–W23

    Article  PubMed  Google Scholar 

  25. Braitstein P, Brinkhof MW, Dabis F, Schechter M, Boulle A, Miotti P et al (2006) Mortality of HIV-1-infected patients in the first year of antiretroviral therapy: comparison between low-income and high-income countries. Lancet 367:817–824

    Article  PubMed  Google Scholar 

  26. Essex M (2009) HIV variability in Africa. In: Kanki P, Marlink R (eds) A line drawn in the sand: responses to the AIDS treatment crisis in Africa. Harvard Center for Population and Development Studies, Cambridge, MA, pp 245–258

    Google Scholar 

  27. Ivers LC, Kendrick D, Doucette K (2005) Efficacy of antiretroviral therapy programs in resource-poor settings: a meta-analysis of the published literature. Clin Infect Dis 41:217–224

    Article  PubMed  CAS  Google Scholar 

  28. Kantor R, Katzenstein D (2003) Polymorphism in HIV-1 non-subtype B protease and reverse transcriptase and its potential impact on drug susceptibility and drug resistance evolution. AIDS Rev 5:25–35

    PubMed  Google Scholar 

  29. Vergne L, Peeters M, Mpoudi-Ngole E, Bourgeois A, Liegeois F, Toure-Kane C et al (2000) Genetic diversity of protease and reverse transcriptase sequences in non-subtype-B human immunodeficiency virus type 1 strains: evidence of many minor drug resistance mutations in treatment-naive patients. J Clin Microbiol 38:3919–3925

    PubMed  CAS  Google Scholar 

  30. Chaplin B, Eisen G, Idoko J, Onwujekwe D, Idigbe E, Adewole I et al (2010) Impact of HIV type 1 subtype on drug resistance mutations in nigerian patients failing first-line therapy. AIDS Res Hum Retrovir 15:1413–1420

    Google Scholar 

  31. Holguin A, Sune C, Hamy F, Soriano V, Klimkait T (2006) Natural polymorphisms in the protease gene modulate the replicative capacity of non-B HIV-1 variants in the absence of drug pressure. J Clin Virol 36:264–271

    Article  PubMed  CAS  Google Scholar 

  32. Van De Vijver DA, Wensing AM, Angarano G, Asjo B, Balotta C, Boeri E et al (2006) The calculated genetic barrier for antiretroviral drug resistance substitutions is largely similar for different HIV-1 subtypes. J Acquir Immune Defic Syndr 41:352–360

    Article  PubMed  Google Scholar 

  33. Taiwo B, Chaplin B, Penugonda S, Meloni S, Akanmu S, Gashau W et al (2010) Suboptimal etravirine activity is common during failure of nevirapine-based combination antiretroviral therapy in a cohort infected with non-B subtype HIV-1. Curr HIV Res 8:194–198

    Article  PubMed  CAS  Google Scholar 

  34. Doualla-Bell F, Avalos A, Brenner B, Gaolathe T, Mine M, Gaseitsiwe S et al (2006) High prevalence of the K65R mutation in human immunodeficiency virus type 1 subtype C isolates from infected patients in Botswana treated with didanosine-based regimens. Antimicrob Agents Chemother 50:4182–4185

    Article  PubMed  CAS  Google Scholar 

  35. Brenner B, Turner D, Oliveira M, Moisi D, Detorio M, Carobene M et al (2003) A V106M mutation in HIV-1 clade C viruses exposed to efavirenz confers cross-resistance to non-nucleoside reverse transcriptase inhibitors. AIDS 17:F1–F5

    Article  PubMed  CAS  Google Scholar 

  36. Eshleman SH, Guay LA, Wang J, Mwatha A, Brown ER, Musoke P et al (2005) Distinct patterns of emergence and fading of K103N and Y181C in women with subtype A vs. D after single-dose nevirapine: HIVNET 012. J Acquir Immune Defic Syndr 40:24–29

    Article  PubMed  CAS  Google Scholar 

  37. Arrive E, Newell ML, Ekouevi DK, Chaix ML, Thiebaut R, Masquelier B et al (2007) Prevalence of resistance to nevirapine in mothers and children after single-dose exposure to prevent vertical transmission of HIV-1: a meta-analysis. Int J Epidemiol 36:1009–1021

    Article  PubMed  Google Scholar 

  38. Phillips AN, Dunn D, Sabin C, Pozniak A, Matthias R, Geretti AM et al (2005) Long term probability of detection of HIV-1 drug resistance after starting antiretroviral therapy in routine clinical practice. AIDS 19:487–494

    Article  PubMed  Google Scholar 

  39. Seyler C, Adje-Toure C, Messou E, Dakoury-Dogbo N, Rouet F, Gabillard D et al (2007) Impact of genotypic drug resistance mutations on clinical and immunological outcomes in HIV-infected adults on HAART in West Africa. AIDS 21:1157–1164

    Article  PubMed  Google Scholar 

  40. Bussmann H, Novitsky V, Wester W, Peter T, Masupu K, Gabaitiri L et al (2005) HIV-1 subtype C drug-resistance background among ARV-naive adults in Botswana. Antivir Chem Chemother 16:103–115

    PubMed  CAS  Google Scholar 

  41. Gordon M, De Oliveira T, Bishop K, Coovadia HM, Madurai L, Engelbrecht S et al (2003) Molecular characteristics of human immunodeficiency virus type 1 subtype C viruses from KwaZulu-Natal, South Africa: implications for vaccine and antiretroviral control strategies. J Virol 77:2587–2599

    Article  PubMed  CAS  Google Scholar 

  42. Koizumi Y, Ndembi N, Miyashita M, Lwembe R, Kageyama S, Mbanya D et al (2006) Emergence of antiretroviral therapy resistance-associated primary mutations among drug-naive HIV-1-infected individuals in rural western Cameroon. J Acquir Immune Defic Syndr 43:15–22

    Article  PubMed  CAS  Google Scholar 

  43. Konings FA, Zhong P, Agwara M, Agyingi L, Zekeng L, Achkar JM et al (2004) Protease mutations in HIV-1 non-B strains infecting drug-naive villagers in Cameroon. AIDS Res Hum Retrovir 20:105–109

    Article  PubMed  CAS  Google Scholar 

  44. Vidal N, Mulanga C, Bazepeo SE, Mwamba JK, Tshimpaka J, Kashi M et al (2006) HIV type 1 pol gene diversity and antiretroviral drug resistance mutations in the Democratic Republic of Congo (DRC). AIDS Res Hum Retrovir 22:202–206

    Article  PubMed  CAS  Google Scholar 

  45. Little SJ, Holte S, Routy JP, Daar ES, Markowitz M, Collier AC et al (2002) Antiretroviral-drug resistance among patients recently infected with HIV. New Engl J Med 347:385–394

    Article  PubMed  CAS  Google Scholar 

  46. Wensing AM, Van De Vijver DA, Angarano G, Asjo B, Balotta C, Boeri E et al (2005) Prevalence of drug-resistant HIV-1 variants in untreated individuals in Europe: implications for clinical management. J Infect Dis 192:958–966

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Immunology and Infectious Diseases, Harvard School of Public Health, 651 Huntington Avenue, Boston, MA, 02115, USA

    Nzovu Ulenga & Phyllis J. Kanki

Authors
  1. Nzovu Ulenga
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  2. Phyllis J. Kanki
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Correspondence to Phyllis J. Kanki .

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Editors and Affiliations

  1. Dept. Immunology & Infectious, Diseases, Harvard School of Public Health, Huntington Ave. 651, Boston, 02115-6017, Massachusetts, USA

    Yichen Lu

  2. Dept. Immunology & Infectious, Diseases, Harvard School of Public Health, Huntington Ave. 651, Boston, 02115-6017, Massachusetts, USA

    Max Essex

  3. , Dept of Immunology & Infectious Diseases, Harvard School of Public Health, Huntington Ave 651, Boston, 02115-6017, Massachusetts, USA

    Chris Chanyasulkit

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Ulenga, N., Kanki, P.J. (2013). HIV Treatment Scale-up in Africa: The Impact of Drug Resistance. In: Lu, Y., Essex, M., Chanyasulkit, C. (eds) HIV/AIDS Treatment in Resource Poor Countries. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-4520-3_5

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  • DOI: https://doi.org/10.1007/978-1-4614-4520-3_5

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-4519-7

  • Online ISBN: 978-1-4614-4520-3

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