PMID- 34046513
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220423
IS  - 2328-8957 (Print)
IS  - 2328-8957 (Electronic)
IS  - 2328-8957 (Linking)
VI  - 8
IP  - 5
DP  - 2021 May
TI  - Emergence of Human Immunodeficiency Virus-1 Drug Resistance During the 3-Month 
      World Health Organization-Recommended Enhanced Adherence Counseling Period in the 
      CART-1 Cohort Study.
PG  - ofab046
LID - 10.1093/ofid/ofab046 [doi]
LID - ofab046
AB  - BACKGROUND: In resource-limited settings, the World Health Organization 
      recommends enhanced adherence counseling (EAC) for individuals with an 
      unsuppressed human immunodeficiency virus (HIV)-1 viral load (VL) and to 
      remeasure VL after 3 months to avoid unnecessary regimen switches. In cases in 
      which this follow-up VL remains unsuppressed, a regimen switch is indicated. We 
      aimed to assess levels of HIV-1 drug resistance before and after the EAC period 
      among people with ongoing viremia (>/=80 c/mL) after EAC. METHODS: We included 
      adult participants of the CART-1 cohort study conducted in Lesotho who had a 
      VL >/=80 c/mL after EAC. Paired plasma samples (before and after EAC) were analyzed 
      by next-generation sequencing. We assessed the prevalence of 
      resistance-associated mutations and viral susceptibility scores to each 
      participant's antiretroviral therapy (ART) regimen (range, 0-3; 3 indicates 
      complete susceptibility). RESULTS: Among 93 participants taking nonnucleoside 
      reverse-transcriptase inhibitor-based ART with an initial VL >/=1000 copies/mL who 
      received a follow-up VL test after EAC, 76 still had a VL >/=80 copies/mL after 
      EAC, and paired samples were available for 57 of 76. The number of individuals 
      without full susceptibility to any drug in their regimen increased from 31 of 57 
      (54.4%) before to 36 of 57 (63.2%) after EAC. Median susceptibility scores 
      dropped from 0.5 (interquartile range [IQR] = 0.25-) to 0.25 (IQR = 0.25-1) 
      during the EAC period (P = .16). CONCLUSIONS: Despite high levels of resistance 
      before EAC, we observed a slight decline in susceptibility scores after EAC. The 
      risk of further accumulation of resistance during EAC has to be balanced against 
      the benefit of avoiding unnecessary switches in those with spontaneous 
      resuppression after EAC.
CI  - (c) The Author(s) 2021. Published by Oxford University Press on behalf of 
      Infectious Diseases Society of America.
FAU - Brown, Jennifer A
AU  - Brown JA
AUID- ORCID: 0000-0003-1874-6153
AD  - Department of Medicine, Swiss Tropical and Public Health Institute, Basel, 
      Switzerland.
AD  - University of Basel, Basel, Switzerland.
AD  - Department of Biomedicine, University of Basel, Basel, Switzerland.
FAU - Mbunkah, Herbert A
AU  - Mbunkah HA
AUID- ORCID: 0000-0002-4671-0281
AD  - Department of Infectious Diseases and Hospital Epidemiology, University Hospital 
      Zurich, Zurich, Switzerland.
AD  - Institute of Medical Virology, University of Zurich, Zurich, Switzerland.
FAU - Lejone, Thabo I
AU  - Lejone TI
AUID- ORCID: 0000-0003-1724-1532
AD  - SolidarMed, Swiss Organization for Health in Africa, Maseru, Lesotho.
FAU - Ringera, Isaac
AU  - Ringera I
AD  - SolidarMed, Swiss Organization for Health in Africa, Maseru, Lesotho.
FAU - Cheleboi, Molisana
AU  - Cheleboi M
AD  - Seboche Mission Hospital, Seboche, Lesotho.
FAU - Klimkait, Thomas
AU  - Klimkait T
AUID- ORCID: 0000-0003-4945-6511
AD  - University of Basel, Basel, Switzerland.
AD  - Department of Biomedicine, University of Basel, Basel, Switzerland.
FAU - Metzner, Karin J
AU  - Metzner KJ
AUID- ORCID: 0000-0003-4862-1503
AD  - Department of Infectious Diseases and Hospital Epidemiology, University Hospital 
      Zurich, Zurich, Switzerland.
AD  - Institute of Medical Virology, University of Zurich, Zurich, Switzerland.
FAU - Gunthard, Huldrych F
AU  - Gunthard HF
AUID- ORCID: 0000-0002-1142-6723
AD  - Department of Infectious Diseases and Hospital Epidemiology, University Hospital 
      Zurich, Zurich, Switzerland.
AD  - Institute of Medical Virology, University of Zurich, Zurich, Switzerland.
FAU - Labhardt, Niklaus D
AU  - Labhardt ND
AUID- ORCID: 0000-0003-3599-1791
AD  - Department of Medicine, Swiss Tropical and Public Health Institute, Basel, 
      Switzerland.
AD  - University of Basel, Basel, Switzerland.
AD  - Department of Infectious Diseases and Hospital Epidemiology, University Hospital 
      Basel, Basel, Switzerland.
FAU - Kouyos, Roger D
AU  - Kouyos RD
AUID- ORCID: 0000-0002-9220-8348
AD  - Department of Infectious Diseases and Hospital Epidemiology, University Hospital 
      Zurich, Zurich, Switzerland.
AD  - Institute of Medical Virology, University of Zurich, Zurich, Switzerland.
FAU - Tschumi, Nadine
AU  - Tschumi N
AUID- ORCID: 0000-0002-7303-9542
AD  - Department of Medicine, Swiss Tropical and Public Health Institute, Basel, 
      Switzerland.
AD  - University of Basel, Basel, Switzerland.
AD  - Department of Infectious Diseases and Hospital Epidemiology, University Hospital 
      Zurich, Zurich, Switzerland.
AD  - Institute of Medical Virology, University of Zurich, Zurich, Switzerland.
LA  - eng
PT  - Journal Article
DEP - 20210202
PL  - United States
TA  - Open Forum Infect Dis
JT  - Open forum infectious diseases
JID - 101637045
PMC - PMC8137466
OTO - NOTNLM
OT  - HIV
OT  - drug resistance
OT  - genotypic resistance testing
OT  - sub-Saharan Africa
EDAT- 2021/05/29 06:00
MHDA- 2021/05/29 06:01
PMCR- 2021/02/02
CRDT- 2021/05/28 07:30
PHST- 2020/09/24 00:00 [received]
PHST- 2021/01/28 00:00 [accepted]
PHST- 2021/05/28 07:30 [entrez]
PHST- 2021/05/29 06:00 [pubmed]
PHST- 2021/05/29 06:01 [medline]
PHST- 2021/02/02 00:00 [pmc-release]
AID - ofab046 [pii]
AID - 10.1093/ofid/ofab046 [doi]
PST - epublish
SO  - Open Forum Infect Dis. 2021 Feb 2;8(5):ofab046. doi: 10.1093/ofid/ofab046. 
      eCollection 2021 May.