Virological monitoring and resistance to first-line highly active antiretroviral therapy in adults infected with HIV-1 treated under WHO guidelines: a systematic review and meta-analysis
Summary Antiretroviral-therapy rollout in resource-poor countries is often associated with limited, if any, HIV-RNA monitoring. The effect of variable monitoring on the emergence of resistance after therapy with commonly used drug combinations was assessed by systematic review of studies reporting r...
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| Veröffentlicht in: | The Lancet infectious diseases 2009-07, Vol.9 (7), p.409-417 |
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| creator | Gupta, Ravindra K, Dr Hill, Andrew, PhD Sawyer, Anthony W, PhD Cozzi-Lepri, Alessandro, PhD von Wyl, Viktor, PhD Yerly, Sabine, PhD Lima, Viviane Dias, PhD Günthard, Huldrych F, Prof Gilks, Charles, Prof Pillay, Deenan, Prof |
| description | Summary Antiretroviral-therapy rollout in resource-poor countries is often associated with limited, if any, HIV-RNA monitoring. The effect of variable monitoring on the emergence of resistance after therapy with commonly used drug combinations was assessed by systematic review of studies reporting resistance in patients infected with HIV with a CD4 count of fewer than 200 cells per μL treated with two nucleoside analogues (including a thymidine analogue) and a non-nucleoside reverse transcriptase inhibitor. 8376 patients from eight cohorts and two prospective studies were analysed. Resistance at virological failure to non-nucleoside reverse transcriptase inhibitors at 48 weeks was 88·3% (95% CI 82·2–92·9) in infrequently monitored patients, compared with 61·0% (48·9–72·2) in frequently monitored patients (p |
| doi_str_mv | 10.1016/S1473-3099(09)70136-7 |
| format | Article |
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The effect of variable monitoring on the emergence of resistance after therapy with commonly used drug combinations was assessed by systematic review of studies reporting resistance in patients infected with HIV with a CD4 count of fewer than 200 cells per μL treated with two nucleoside analogues (including a thymidine analogue) and a non-nucleoside reverse transcriptase inhibitor. 8376 patients from eight cohorts and two prospective studies were analysed. Resistance at virological failure to non-nucleoside reverse transcriptase inhibitors at 48 weeks was 88·3% (95% CI 82·2–92·9) in infrequently monitored patients, compared with 61·0% (48·9–72·2) in frequently monitored patients (p<0·001). Lamivudine resistance was 80·5% (72·9–86·8) and 40·3% (29·1–52·2) in infrequently and frequently monitored patients, respectively (p<0·001); the prevalence of at least one thymidine analogue mutation was 27·8% (21·2–35·2) and 12·1% (5·9–21·4), respectively (p<0·001). Genotypic resistance at 48 weeks to lamivudine, nucleoside reverse transcriptase inhibitors (thymidine analogue mutations), and non-nucleoside reverse transcriptase inhibitors appears substantially higher in less frequently monitored patients. This Review highlights the need for cheap point-of-care viral-load tests to identify early viral failures and limit the emergence of resistance.</description><identifier>ISSN: 1473-3099</identifier><identifier>EISSN: 1474-4457</identifier><identifier>DOI: 10.1016/S1473-3099(09)70136-7</identifier><identifier>PMID: 19555900</identifier><identifier>CODEN: LANCAO</identifier><language>eng</language><publisher>London: Elsevier Ltd</publisher><subject>Adult ; Anti-HIV Agents - pharmacology ; Anti-HIV Agents - therapeutic use ; Antibiotics. Antiinfectious agents. Antiparasitic agents ; Antiretroviral agents ; Antiretroviral Therapy, Highly Active ; Antiviral agents ; Biological and medical sciences ; Drug Monitoring ; Drug Resistance, Viral ; Female ; HIV Infections - drug therapy ; HIV-1 - drug effects ; HIV-1 - isolation & purification ; Human viral diseases ; Humans ; Immunodeficiencies ; Immunodeficiencies. Immunoglobulinopathies ; Immunopathology ; Infectious Disease ; Infectious diseases ; Inhibitors ; Male ; Medical sciences ; Mutation ; Pharmacology. Drug treatments ; RNA, Viral - blood ; Treatment Failure ; Treatment Outcome ; Viral diseases ; Viral diseases of the lymphoid tissue and the blood. Aids ; Viral Load</subject><ispartof>The Lancet infectious diseases, 2009-07, Vol.9 (7), p.409-417</ispartof><rights>Elsevier Ltd</rights><rights>2009 Elsevier Ltd</rights><rights>2009 INIST-CNRS</rights><rights>Copyright Elsevier Limited Jul 2009</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c475t-5a55c8a5ad09ae1185cc5d7c400fff642ddbe10bfd32d013de8973859f326d3a3</citedby><cites>FETCH-LOGICAL-c475t-5a55c8a5ad09ae1185cc5d7c400fff642ddbe10bfd32d013de8973859f326d3a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/201577021?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,777,781,3537,27905,27906,45976,64364,64366,64368,72218</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21649556$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19555900$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gupta, Ravindra K, Dr</creatorcontrib><creatorcontrib>Hill, Andrew, PhD</creatorcontrib><creatorcontrib>Sawyer, Anthony W, PhD</creatorcontrib><creatorcontrib>Cozzi-Lepri, Alessandro, PhD</creatorcontrib><creatorcontrib>von Wyl, Viktor, PhD</creatorcontrib><creatorcontrib>Yerly, Sabine, PhD</creatorcontrib><creatorcontrib>Lima, Viviane Dias, PhD</creatorcontrib><creatorcontrib>Günthard, Huldrych F, Prof</creatorcontrib><creatorcontrib>Gilks, Charles, Prof</creatorcontrib><creatorcontrib>Pillay, Deenan, Prof</creatorcontrib><title>Virological monitoring and resistance to first-line highly active antiretroviral therapy in adults infected with HIV-1 treated under WHO guidelines: a systematic review and meta-analysis</title><title>The Lancet infectious diseases</title><addtitle>Lancet Infect Dis</addtitle><description>Summary Antiretroviral-therapy rollout in resource-poor countries is often associated with limited, if any, HIV-RNA monitoring. The effect of variable monitoring on the emergence of resistance after therapy with commonly used drug combinations was assessed by systematic review of studies reporting resistance in patients infected with HIV with a CD4 count of fewer than 200 cells per μL treated with two nucleoside analogues (including a thymidine analogue) and a non-nucleoside reverse transcriptase inhibitor. 8376 patients from eight cohorts and two prospective studies were analysed. Resistance at virological failure to non-nucleoside reverse transcriptase inhibitors at 48 weeks was 88·3% (95% CI 82·2–92·9) in infrequently monitored patients, compared with 61·0% (48·9–72·2) in frequently monitored patients (p<0·001). Lamivudine resistance was 80·5% (72·9–86·8) and 40·3% (29·1–52·2) in infrequently and frequently monitored patients, respectively (p<0·001); the prevalence of at least one thymidine analogue mutation was 27·8% (21·2–35·2) and 12·1% (5·9–21·4), respectively (p<0·001). Genotypic resistance at 48 weeks to lamivudine, nucleoside reverse transcriptase inhibitors (thymidine analogue mutations), and non-nucleoside reverse transcriptase inhibitors appears substantially higher in less frequently monitored patients. This Review highlights the need for cheap point-of-care viral-load tests to identify early viral failures and limit the emergence of resistance.</description><subject>Adult</subject><subject>Anti-HIV Agents - pharmacology</subject><subject>Anti-HIV Agents - therapeutic use</subject><subject>Antibiotics. Antiinfectious agents. Antiparasitic agents</subject><subject>Antiretroviral agents</subject><subject>Antiretroviral Therapy, Highly Active</subject><subject>Antiviral agents</subject><subject>Biological and medical sciences</subject><subject>Drug Monitoring</subject><subject>Drug Resistance, Viral</subject><subject>Female</subject><subject>HIV Infections - drug therapy</subject><subject>HIV-1 - drug effects</subject><subject>HIV-1 - isolation & purification</subject><subject>Human viral diseases</subject><subject>Humans</subject><subject>Immunodeficiencies</subject><subject>Immunodeficiencies. Immunoglobulinopathies</subject><subject>Immunopathology</subject><subject>Infectious Disease</subject><subject>Infectious diseases</subject><subject>Inhibitors</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Mutation</subject><subject>Pharmacology. Drug treatments</subject><subject>RNA, Viral - blood</subject><subject>Treatment Failure</subject><subject>Treatment Outcome</subject><subject>Viral diseases</subject><subject>Viral diseases of the lymphoid tissue and the blood. 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Antiinfectious agents. Antiparasitic agents</topic><topic>Antiretroviral agents</topic><topic>Antiretroviral Therapy, Highly Active</topic><topic>Antiviral agents</topic><topic>Biological and medical sciences</topic><topic>Drug Monitoring</topic><topic>Drug Resistance, Viral</topic><topic>Female</topic><topic>HIV Infections - drug therapy</topic><topic>HIV-1 - drug effects</topic><topic>HIV-1 - isolation & purification</topic><topic>Human viral diseases</topic><topic>Humans</topic><topic>Immunodeficiencies</topic><topic>Immunodeficiencies. Immunoglobulinopathies</topic><topic>Immunopathology</topic><topic>Infectious Disease</topic><topic>Infectious diseases</topic><topic>Inhibitors</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Mutation</topic><topic>Pharmacology. Drug treatments</topic><topic>RNA, Viral - blood</topic><topic>Treatment Failure</topic><topic>Treatment Outcome</topic><topic>Viral diseases</topic><topic>Viral diseases of the lymphoid tissue and the blood. 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The effect of variable monitoring on the emergence of resistance after therapy with commonly used drug combinations was assessed by systematic review of studies reporting resistance in patients infected with HIV with a CD4 count of fewer than 200 cells per μL treated with two nucleoside analogues (including a thymidine analogue) and a non-nucleoside reverse transcriptase inhibitor. 8376 patients from eight cohorts and two prospective studies were analysed. Resistance at virological failure to non-nucleoside reverse transcriptase inhibitors at 48 weeks was 88·3% (95% CI 82·2–92·9) in infrequently monitored patients, compared with 61·0% (48·9–72·2) in frequently monitored patients (p<0·001). Lamivudine resistance was 80·5% (72·9–86·8) and 40·3% (29·1–52·2) in infrequently and frequently monitored patients, respectively (p<0·001); the prevalence of at least one thymidine analogue mutation was 27·8% (21·2–35·2) and 12·1% (5·9–21·4), respectively (p<0·001). Genotypic resistance at 48 weeks to lamivudine, nucleoside reverse transcriptase inhibitors (thymidine analogue mutations), and non-nucleoside reverse transcriptase inhibitors appears substantially higher in less frequently monitored patients. This Review highlights the need for cheap point-of-care viral-load tests to identify early viral failures and limit the emergence of resistance.</abstract><cop>London</cop><pub>Elsevier Ltd</pub><pmid>19555900</pmid><doi>10.1016/S1473-3099(09)70136-7</doi><tpages>9</tpages></addata></record> |
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| subjects | Adult Anti-HIV Agents - pharmacology Anti-HIV Agents - therapeutic use Antibiotics. Antiinfectious agents. Antiparasitic agents Antiretroviral agents Antiretroviral Therapy, Highly Active Antiviral agents Biological and medical sciences Drug Monitoring Drug Resistance, Viral Female HIV Infections - drug therapy HIV-1 - drug effects HIV-1 - isolation & purification Human viral diseases Humans Immunodeficiencies Immunodeficiencies. Immunoglobulinopathies Immunopathology Infectious Disease Infectious diseases Inhibitors Male Medical sciences Mutation Pharmacology. Drug treatments RNA, Viral - blood Treatment Failure Treatment Outcome Viral diseases Viral diseases of the lymphoid tissue and the blood. Aids Viral Load |
| title | Virological monitoring and resistance to first-line highly active antiretroviral therapy in adults infected with HIV-1 treated under WHO guidelines: a systematic review and meta-analysis |
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