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Current opinion in HIV and AIDS
07 01, 2022;17 (4): 229-239.

Epidemiology of HIV drug resistance in low- and middle-income countries and WHO global strategy to monitor its emergence.

Silvia Bertagnolio, Michael R Jordan, Amalia Giron, Seth Inzaule
Author Information
  1. Silvia Bertagnolio: World Health Organization, Geneva, Switzerland.
  2. Michael R Jordan: Stuart B. Levy Center for Integrated Management of Antimicrobial Resistance, Tufts University School of Medicine, Boston, Massachusetts, USA.
  3. Amalia Giron: World Health Organization, Geneva, Switzerland.
  4. Seth Inzaule: World Health Organization, Geneva, Switzerland.
PMID: 35762378 DOI: 10.1097/COH.0000000000000743

Abstract

PURPOSE OF REVIEW: This review summarises the latest information of the epidemiology of HIV drug resistance (HIVDR) in low- and middle-income countries and the updated WHO global strategy for HIVDR surveillance and monitoring.
RECENT FINDINGS: Finding from recent national-representative surveys show a rise in pretreatment drug resistance (PDR) to reverse transcriptase inhibitors and especially to the class of nonnucleoside reverse transcriptase inhibitors. Levels of PDR are especially high in infants <18 months and adults reporting prior exposure to antiretrovirals. Although viral suppression rates are generally high and increasing among adults on antiretroviral therapy, those with unsuppressed viremia have high levels of acquired drug resistance (ADR). Programmatic data on HIVDR to integrase-transfer-inhibitor resistance is scarce, highlighting the need to increase integrase-inhibitors resistance surveillance. As the landscape of HIV prevention, treatment and monitoring evolves, WHO has also adapted its strategy to effectively support countries in preventing and monitoring the emergence of HIVDR. This includes new survey methods for monitoring resistance emerging from patients diagnosed with HIV while on preexposure prophylaxis, and a laboratory-based ADR survey leveraging on remnant viral load specimens which are expected to strengthen dolutegravir-resistance surveillance.
SUMMARY: Monitoring HIVDR remains pivotal to ensure countries attain and sustain the global goals for ending HIV as a public health threat by 2030.

References

  1. UNAIDS. UNAIDS Data 2021, 2021. https://www.unaids.org/sites/default/files/media_asset/JC3032_AIDS_Data_book_2021_En.pdf [Accessed 27 May 2022].
  2. World Health Organization(WHO). Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach 2021, 2021. https://www.who.int/publications/i/item/9789240031593 . [Accessed 27 May 2022]
  3. World Health Organization(WHO). HIV drug resistance strategy 2021 update, 2021. https://www.who.int/publications/i/item/9789240030565 [Accessed 27 May 2022].
  4. World Health Organization(WHO); HIV drug resistance report 2021, 2021. https://www.who.int/publications/i/item/9789240038608 [Accessed 27 May 2022].
  5. World Health Organization. HIV drug resistance report 2017, 2017. http://apps.who.int/iris/bitstream/10665/255896/1/9789241512831-eng.pdf?ua=1 [Accessed 27 May 2022].
  6. Gupta RK, et al. HIV-1 drug resistance before initiation or re-initiation of first-line antiretroviral therapy in low-income and middle-income countries: a systematic review and meta-regression analysis. Lancet Infect Dis 2017; doi:10.1016/S1473-3099(17)30702-8. [DOI: 10.1016/S1473-3099(17)30702-8]
  7. Phillips AN, et al. Impact of HIV drug resistance on HIV/AIDS-associated mortality, new infections, and antiretroviral therapy program costs in Sub–Saharan Africa. J Infect Dis 2017; 215:1362–1365.
  8. World Health Organization. Updated recommendations on first-line and second-line antiretroviral regimens and postexposure prophylaxis and recommendations on early infant diagnosis of HIV:Interim guidance, 2018. https://www.who.int/publications/i/item/WHO-CDS-HIV-18.51 [Accessed 27 May 2022].
  9. World Health Organization. Guidelines on the public health response to pretreatment HIV drug resistance, 2017. http://apps.who.int/iris/bitstream/10665/255880/1/9789241550055-eng.pdf?ua=1 [Accessed 27 May 2022].
  10. Casadellà M, et al. Primary resistance to integrase strand-transfer inhibitors in Europe. J Antimicrob Chemother 2015; 70:2885–2888.
  11. Inzaule SC, et al. Primary resistance to integrase strand transfer inhibitors in patients infected with diverse HIV-1 subtypes in sub-Saharan Africa. J Antimicrob Chemother 2018; 73:1167–1172.
  12. Tzou PL, et al. Integrase strand transfer inhibitor (INSTI)-resistance mutations for the surveillance of transmitted HIV-1 drug resistance. J Antimicrob Chemother 2020; 75:170–182.
  13. Rocheleau G, Brumme CJ, Shoveller J, et al. Longitudinal trends of HIV drug resistance in a large Canadian cohort, 1996-2016. Clin Microbiol Infect 2018; 24:185–191.
  14. Kantzanou M, et al. Transmitted drug resistance among HIV-1 drug-naïve patients in Greece. Int J Infect Dis IJID Off Publ Int Soc Infect Dis 2021; 105:42–48.
  15. Colby DJ, et al. Declining trend in transmitted drug resistance detected in a prospective cohort study of acute HIV infection in Bangkok. Thailand J Int AIDS Soc 2016; 19:20966.
  16. Li R, et al. Prevalence of transmitted drug resistance among ART-naïve HIV-infected individuals, Beijing, 2015-2018. J Glob Antimicrob Resist 2022; 28:241–248.
  17. Muccini C, et al. Brief report: prevalence trend of transmitted drug resistance in a prospective cohort of Thai People with acute HIV infection. JAIDS J Acquir Immune Defic Syndr 2021; 87:
  18. Huang S-W, et al. High prevalence of HIV-1 transmitted drug resistance and factors associated with time to virological failure and viral suppression in Taiwan. J Antimicrob Chemother 2021; 77:185–195.
  19. Guo C, et al. Transmitted drug resistance in antiretroviral therapy-naive persons with acute/early/primary HIV infection: a systematic review and meta-analysis. Front Pharmacol 2021; 12:718763.
  20. Baxter JD, et al. Transmitted HIV-1 drug resistance in a large international cohort using next-generation sequencing: results from the Strategic Timing of Antiretroviral Treatment (START) study. HIV Med 2021; 22:360–371.
  21. Wagner T, et al. Epidemiology and transmitted HIV-1 drug resistance among treatment-naïve individuals in Israel, 2010-2018. Viruses 2021; 14:71.
  22. McClung RP, et al. Transmitted drug resistance among human immunodeficiency virus (HIV)-1 diagnoses in the United States, 2014-2018. Clin Infect Dis 2021; ciab583doi:10.1093/cid/ciab583. [DOI: 10.1093/cid/ciab583]
  23. Clinton Health Access Initiative. HIV market report: The state of HIV treatment, testing, and prevention in low- and middle-income countries, 2021. https://3cdmh310dov3470e6x160esb-wpengine.netdna-ssl.com/wp-content/uploads/2020/09/2020-CHAI-HIV-Market-Report.pdf [Accessed 30 January 2022].
  24. Louis FJ, et al. High Levels of HIV-1 drug resistance in children who acquired HIV infection through mother to child transmission in the era of option B+, Haiti, 2013 to 2014. Pediatr Infect Dis J 2019; 38:503–507.
  25. Poppe LK, et al. HIV drug resistance in infants increases with changing prevention of mother-to-child transmission regimens. AIDS 2017; 31:1885–1889.
  26. Kingwara L, et al. Impact of nucleos(t)ide reverse transcriptase inhibitor resistance on dolutegravir and protease-inhibitor based regimens in children and adolescents in Kenya. AIDS 2021; doi:10.1097/QAD.0000000000003154. [DOI: 10.1097/QAD.0000000000003154]
  27. Keene CM, et al. Virologic efficacy of tenofovir, lamivudine and dolutegravir as second-line antiretroviral therapy in adults failing a tenofovir-based first-line regimen. AIDS 2021; 35:1423–1432.
  28. Paton NI, et al. Dolutegravir or darunavir in combination with zidovudine or tenofovir to treat HIV. N Engl J Med 2021; 385:330–341.
  29. Stockdale AJ, et al. Effectiveness of protease inhibitor/nucleos(t)ide reverse transcriptase inhibitor–based second-line antiretroviral therapy for the treatment of human immunodeficiency virus type 1 infection in Sub-Saharan Africa: a systematic review and meta-analysis. Clin Infect Dis 2017; cix1108doi:10.1093/cid/cix1108. [DOI: 10.1093/cid/cix1108]
  30. Temfack E. et al. Prospective enhanced monitoring of dolutegravir-based first line in Malawi. In Conference on Retroviruses and Opportunistic Infections (CROI), 2020.
  31. World Health Organization. World Health Organization Global Strategy for the Surveillance and Monitoring of HIV Drug Resistance, 2012. http://apps.who.int/iris/bitstream/10665/77349/1/9789241504768_eng.pdf [Accessed 25 February 2016].
  32. Bennett DE, Bertagnolio S, Sutherland D, Gilks CF. The World Health Organization's global strategy for prevention and assessment of HIV drug resistance. Antiviral Ther 2008; 13:
  33. World Health Organization. HIV drug resistance surveillance guidance: 2015 update, 2015. http://apps.who.int/iris/bitstream/10665/204471/1/9789241510097_eng.pdf?ua=1 [Accessed 22 March 2016].
  34. Gibas KM, van den Berg P, Powell VE, Krakower DS. Drug resistance during HIV pre-exposure prophylaxis. Drugs 2019; 79:609–619.
  35. World Health Organization. HIV drug resistance surveillance in countries scaling up preexposure prophylaxis, 2020. https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/hiv/treatment/hiv-drug-resistance/hiv-drug-resistance-surveillance/hiv-drug-resistance-among-prep-users-diagnosed-with-hiv [Accessed 17 August 2021].
  36. World Health Organization. Surveillance of HIV drug resistance in populations initiating antiretroviral therapy (pretreatment HIV drug resistance), 2014. https://www.who.int/publications/i/item/9789241507196 . [Accessed 27 May 2022]
  37. World Health Organization. Surveillance of HIV drug resistance in children newly diagnosed with HIV by early infant diagnosis, 2017. https://www.who.int/publications/i/item/9789241512541 . [Accessed 27 May 2022]
  38. Waitt CJ, Garner P, Bonnett LJ, et al. Is infant exposure to antiretroviral drugs during breastfeeding quantitatively important? A systematic review and meta-analysis of pharmacokinetic studies. J Antimicrob Chemother 2015; 70:1928–1941.
  39. World Health Organization. Laboratory-based survey of acquired HIV drug resistance using remnant viral load specimens, 2021. https://www.who.int/publications/i/item/9789240025417 [Accessed 31 January 2022].
  40. World Health Organization. Clinic-based survey of acquired HIV drug resistance, 2021. https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/hiv/treatment/hiv-drug-resistance/hiv-drug-resistance-surveillance/surveillance-of-acquired-hiv-drug-resistance-in-populations-receiving-art [Accessed 31 January 2022].
  41. World Health Organization. WHO/HIVResNet HIV drug resistance laboratory operational framework-second edition, 2020. https://www.who.int/publications/i/item/978-92-4-000987-5 [Accessed 16 June 2021].
  42. World Health Organization. Global action plan for HIV drug resistance 2017-2021. WHO Geneva, 2017 http://apps.who.int/iris/bitstream/10665/255883/1/9789241512848-eng.pdf?ua=1 [Accessed 23 April 2021].

Grants

  1. 001/World Health Organization

MeSH Term

Adult
Anti-HIV Agents
Developing Countries
Drug Resistance, Viral
HIV Infections
Humans
Reverse Transcriptase Inhibitors
Viral Load
World Health Organization

Chemicals

Anti-HIV Agents
Reverse Transcriptase Inhibitors
Journal Article Review

Word Cloud

Created with Highcharts 10.0.0resistanceHIVHIVDRdrugcountriesmonitoringWHOglobalstrategysurveillancehighlow-middle-incomePDRreversetranscriptaseinhibitorsespeciallyadultsviralADRemergencesurveyPURPOSEOFREVIEW:reviewsummariseslatestinformationepidemiologyupdatedRECENTFINDINGS:Findingrecentnational-representativesurveysshowrisepretreatmentclassnonnucleosideLevelsinfants<18 monthsreportingpriorexposureantiretroviralsAlthoughsuppressionratesgenerallyincreasingamongantiretroviraltherapyunsuppressedviremialevelsacquiredProgrammaticdataintegrase-transfer-inhibitorscarcehighlightingneedincreaseintegrase-inhibitorslandscapepreventiontreatmentevolvesalsoadaptedeffectivelysupportpreventingincludesnewmethodsemergingpatientsdiagnosedpreexposureprophylaxislaboratory-basedleveragingremnantloadspecimensexpectedstrengthendolutegravir-resistanceSUMMARY:Monitoringremainspivotalensureattainsustaingoalsendingpublichealththreat2030Epidemiologymonitor

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