Academic journal article Journal of Health Population and Nutrition

Prevalence of Antiretroviral Drug Resistance Mutations and HIV-1 Subtypes among Newly-Diagnosed Drug-Naïve Persons Visiting a Voluntary Testing and Counselling Centre in Northeastern South Africa

Academic journal article Journal of Health Population and Nutrition

Prevalence of Antiretroviral Drug Resistance Mutations and HIV-1 Subtypes among Newly-Diagnosed Drug-Naïve Persons Visiting a Voluntary Testing and Counselling Centre in Northeastern South Africa

Article excerpt

INTRODUCTION

The health and quality of life of patients infected with HIV/AIDS have dramatically improved since the introduction of highly-active antiretroviral therapy (HAART) in 1996 (1,2). However, one of the major drawbacks of HAART is the development of drug resistance which usually accompanies the use of antiretrovirals (ARVs) (2,3). Drug-naïve individuals with ARV drug resistance have a relatively higher risk of virologic failure as they start antiretroviral treatment (ART) with a lower genetic barrier to resistance (4). In addition, harbouring resistance viruses before the initiation of treatment complicates alternative treatment algorithms.

In the developed world, HAART has been used with remarkable success, and treatment is accompanied with regular virologic monitoring, including measurements of viral load and testing of drug resistance to guide management of patients (5,6). On the other hand, the use of HAART in resource-poor settings still poses a lot of problems. Virological monitoring is less frequently done due to involvement of cost and dearth of qualified personnel.

South Africa has one of the highest HIV/AIDS prevalence in the world, and the South African National HIV and Syphilis Survey in 2007 showed that the estimated prevalence was 28% (7), with the Limpopo province (northeastern South Africa) having a prevalence of 20.7%. Before 2004, ARVs were available only through private health establishments in South Africa, and due to the scarcity and prohibitive high cost, the majority of patients could not afford treatment. In early 2004, a national ARV delivery programme was initiated to provide drugs to those who had a CD4 count of <200 cells/µL or with a clinically-defined AIDS condition. Before 2010, the South African ARV drug regimen guideline recommended the use of stavudine, lamivudine, and efavirenz (with nevirapine replacing efavirenz for women of childbearing age). Currently, the revised regimen comprises tenofovir, lamivudine, and efavirenz/ nevirapine. Stavudine is still recommended where side-effects are tolerated (8).

The determination of a regimen based on the genetic resistance profiles of patients' viruses before the initiation of therapy generally correlates with a better outcome compared to the absence of such resistance data (3,9). Information on the presence of resistant viruses is important in tailoring combination regimens or to decide whether to prescribe testing of resistance before the initiation of therapy. It was estimated that 500,000 adults and children were receiving ARVs in South Africa by mid-2008, with about 34,000 of them in Limpopo province (northern South Africa) (10). In South Africa, some studies have indicated the prevalence of genetic drug resistance among the naïve population of less than 5% (9,11). However, despite the low prevalence reported, it is important to monitor the prevalence of drug resistance in drug-naïve populations, particularly in regions, such as northeast of South Africa where such data are scarce. The only data on resistance available for northern South Africa were obtained from samples collected in 2001 from Waterberg district (10,12) before the availability of ARVs through the public health sector in 2004. Findings of these studies showed the absence of resistance mutations in the samples studied. In addition, since 2004, access to ARVs has escalated in northern South Africa (from an estimated 300 in 2001 to 34,000 in 2008) (11), and it is important to address development of drug resistance through periodic studies. The aim of this study was, therefore, to provide baseline data on ARV drug resistance mutations in Mankweng (Capricorn district), one of the areas where ART first began in northeastern South Africa in 2004 and where no resistance data are available. Information generated could be useful in developing sentinel surveillance policies for the region.

MATERIALS AND METHODS

Study population, sample collection, and plasma preparation

Individuals without prior exposure to ARVs and who tested positive for HIV antibodies at the HIV Voluntary Testing and Counselling Centre at the Mankweng Hospital, South Africa, were recruited sequentially during February 2008-December 2008. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.