PLoS ONE (Jan 2011)

HIV drug resistance (HIVDR) in antiretroviral therapy-naïve patients in Tanzania not eligible for WHO threshold HIVDR survey is dramatically high.

  • Christa Kasang,
  • Samuel Kalluvya,
  • Charles Majinge,
  • August Stich,
  • Jochen Bodem,
  • Gilbert Kongola,
  • Graeme B Jacobs,
  • Mathias Mlewa,
  • Miriam Mildner,
  • Irina Hensel,
  • Anne Horn,
  • Wolfgang Preiser,
  • Gert van Zyl,
  • Hartwig Klinker,
  • Eleni Koutsilieri,
  • Axel Rethwilm,
  • Carsten Scheller,
  • Benedikt Weissbrich

DOI
https://doi.org/10.1371/journal.pone.0023091
Journal volume & issue
Vol. 6, no. 8
p. e23091

Abstract

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The World Health Organization (WHO) has recommended guidelines for a HIV drug resistance (HIVDR) survey for resource-limited countries. Eligibility criteria for patients include age below 25 years in order to focus on the prevalence of transmitted HIVDR (tHIVDR) in newly-infected individuals. Most of the participating sites across Africa have so far reported tHIVDR prevalences of below 5%. In this study we investigated whether the rate of HIVDR in patients 25 years had a significantly higher HIVDR frequency than younger patients (19.1%; 95% CI 0.095-0.28) versus 0%, P = 0.0344). In 2 out of the 16 patients with HIVDR we found traces of antiretrovirals (ARVs) in plasma.ART-naïve patients aged over 25 years exhibited significantly higher HIVDR than younger patients. Detection of traces of ARVs in individuals with HIVDR suggests that besides transmission, undisclosed misuse of ARVs may constitute a significant factor in the generation of the observed high HIVDR rate. The current WHO tHIVDR survey that is solely focused on the transmission of HIVDR and that excludes patients over 25 years of age may therefore result in substantial underestimation of the prevalence of HIVDR in the therapy-naïve population. Similar studies should be performed also in other areas to test whether the so far reported optimistic picture of low HIVDR prevalence in young individuals is really representative for the rest of the ART-naïve HIV-infected population.