Advancing HIV Drug Resistance Technologies and Strategies: Insights from South Africa’s Experience and Future Directions for Resource-Limited Settings
Kim Steegen,
Gert U. van Zyl,
Mathilda Claassen,
Aabida Khan,
Melendhran Pillay,
Subitha Govender,
Phillip A. Bester,
Johanna M. van Straaten,
Vibha Kana,
Ewaldé Cutler,
Monalisa N. Kalimashe,
Ramokone L. Lebelo,
Mokopi B. H. Moloi,
Lucia Hans
Affiliations
Kim Steegen
Department of Molecular Medicine and Haematology, National Health Laboratory Service, Charlotte Maxeke Johannesburg Hospital, Johannesburg 2193, South Africa
Gert U. van Zyl
Division of Medical Virology, Stellenbosh University, Stellenbosh 7602, South Africa
Mathilda Claassen
Division of Medical Virology, Stellenbosh University, Stellenbosh 7602, South Africa
Aabida Khan
Department of Virology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
Melendhran Pillay
Department of Virology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
Subitha Govender
Department of Virology, National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital, Durban 4058, South Africa
Phillip A. Bester
Department of Medical Microbiology and Virology, University of the Free State, Bloemfontein 9300, South Africa
Johanna M. van Straaten
Department of Medical Microbiology and Virology, National Health Laboratory Service, Universitas Academic Hospital, Bloemfontein 9301, South Africa
Vibha Kana
Centre for HIV and STIs, National Institute for Communicable Diseases, Johannesburg 2192, South Africa
Ewaldé Cutler
Centre for HIV and STIs, National Institute for Communicable Diseases, Johannesburg 2192, South Africa
Monalisa N. Kalimashe
Centre for HIV and STIs, National Institute for Communicable Diseases, Johannesburg 2192, South Africa
Ramokone L. Lebelo
Department of Virological Pathology, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
Mokopi B. H. Moloi
Department of Virological Pathology, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
Lucia Hans
Department of Molecular Medicine and Haematology, National Health Laboratory Service, Charlotte Maxeke Johannesburg Hospital, Johannesburg 2193, South Africa
Monitoring of HIV drug resistance (HIVDR) remains critical for ensuring countries attain and sustain the global goals for ending HIV as a public health threat by 2030. On an individual patient level, drug resistance results assist in ensuring unnecessary treatment switches are avoided and subsequent regimens are tailored on a case-by-case basis, should resistance be detected. Although there is a disparity in access to HIVDR testing in high-income countries compared to low- and middle-income countries (LMICS), more LMICs have now included HIVDR testing for individual patient management in some groups of patients. In this review, we describe different strategies for surveillance as well as where HIVDR testing can be implemented for individual patient management. In addition, we briefly review available technologies for HIVDR testing in LMICs, including Sanger sequencing, next-generation sequencing, and some point-of-care options. Finally, we describe how South Africa has implemented HIVDR testing in the public sector.
