PMID- 28857824
OWN - NLM
STAT- MEDLINE
DCOM- 20190204
LR  - 20220408
IS  - 1473-5571 (Electronic)
IS  - 0269-9370 (Linking)
VI  - 31
IP  - 17
DP  - 2017 Nov
TI  - Moderate levels of pre-therapy drug resistance (PDR) in a generalised epidemic: 
      time for better first-line ART?
PG  - 2387-2391
LID - 10.1097/QAD.0000000000001629 [doi]
AB  - BACKGROUND: The WHO-recommended first-line antiretroviral therapy (ART) as a 
      fixed dose combination (FDC) of efavirenz (EFV) and tenofovir disoproxil fumarate 
      (TDF) with lamivudine (3TC) or emtricitabine (FTC) has been preferred in the 
      large scale unprecedented ART roll out in Southern Africa. Models and recent 
      reports suggest that pre-ART HIV drug resistance (PDR) is increasing with high 
      treatment coverage. METHOD: We therefore investigated PDR and any local 
      transmission clusters in a setting where high treatment coverage was further 
      enhanced by universal test and treat (UTT). Surveillance drug resistance 
      mutations (SDRMs) were identified with an in-house PCR and population sequencing 
      method and calibrated population resistance (CPR) tool. RESULTS: Of 60 patients, 
      six (10%) had an SDRM mutation: five (8.3%) had nonnucleoside reverse 
      transcriptase (NNRT) mutations, one had an nucleos(t)ide reverse transcriptase 
      inhibitor mutation and none had protease inhibitor (PI) mutations. Phylogenetic 
      analysis revealed no large transmission clusters. CONCLUSION: An increase to the 
      current moderate PDR levels and the better tolerability and durability, may 
      support a recent drive to avail FDC integrase strand transfer inhibitor 
      (ISTI)-based regimens as the new preferred first-line ART in the Southern African 
      region for individual benefit and to contribute to limiting transmission of 
      infection and drug resistant virus.
FAU - van Zyl, Gert U
AU  - van Zyl GU
AD  - aSouth African Medical Research Council Collaborating Centre TygHIVLab, Division 
      of Medical Virology, Stellenbosch University, South Africa bNational Health 
      Laboratory Service, Tygerberg Business Unit, South Africa cANOVA Health Institute 
      dDesmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch 
      University, South Africa.
FAU - Grobbelaar, Cornelis J
AU  - Grobbelaar CJ
FAU - Claassen, Mathilda
AU  - Claassen M
FAU - Bock, Peter
AU  - Bock P
FAU - Preiser, Wolfgang
AU  - Preiser W
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20170828
PL  - England
TA  - AIDS
JT  - AIDS (London, England)
JID - 8710219
RN  - 0 (Anti-Retroviral Agents)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Africa, Southern/epidemiology
MH  - Anti-Retroviral Agents/administration & dosage/*pharmacology
MH  - Antiretroviral Therapy, Highly Active/*methods
MH  - Disease Transmission, Infectious
MH  - *Drug Resistance, Viral
MH  - *Epidemics
MH  - Female
MH  - Genotyping Techniques
MH  - HIV Infections/drug therapy/*epidemiology/transmission/*virology
MH  - Humans
MH  - Male
MH  - Microbial Sensitivity Tests
MH  - Middle Aged
MH  - Mutation
MH  - Polymerase Chain Reaction
MH  - Prevalence
MH  - Young Adult
EDAT- 2017/09/01 06:00
MHDA- 2019/02/05 06:00
CRDT- 2017/09/01 06:00
PHST- 2017/09/01 06:00 [entrez]
PHST- 2017/09/01 06:00 [pubmed]
PHST- 2019/02/05 06:00 [medline]
AID - 10.1097/QAD.0000000000001629 [doi]
PST - ppublish
SO  - AIDS. 2017 Nov;31(17):2387-2391. doi: 10.1097/QAD.0000000000001629. Epub 2017 Aug 
      28.