Emerging HIV-1 drug resistance after roll-out of antiretroviral therapy in sub-Saharan Africa

Raph L. Hamers, Kim C E Sigaloff, Cissy Kityo, Peter Mugyenyi, Tobias F Rinke De Wit

Research output: Contribution to journalReview articleAcademicpeer-review

Abstract

PURPOSE OF REVIEW: This review provides an update of recent data on the development of HIV-1 drug resistance during treatment and its transmission in sub-Saharan Africa after the scale-up of antiretroviral therapy (ART). RECENT FINDINGS: Evidence is accumulating of a rising prevalence of transmitted HIV drug resistance (TDR), predominantly associated with nonnucleoside reverse transcriptase inhibitors (NNRTIs), in east and southern Africa. Pretherapy resistance is associated with first-line therapy failure. Accumulation of resistance mutations during first-line failure can be prevented by early detection and timely switching to second-line ART. Important gaps in service delivery and programme performance, associated with resistance development, affect a considerable proportion of ART programmes, particularly with respect to inadequate supply systems and patient retention. The reduction in new HIV infections associated with earlier use of ART is predicted to outweigh the risk of increasing TDR. Future levels of TDR are estimated to be diminished by improving switching practices to second-line regimens. SUMMARY: TDR is on the rise after the recent scale-up of ART in Africa. To prevent the development and spread of drug resistance and sustain the effectiveness of ART programmes, there is a need to improve drug supply systems, patient retention and access to routine viral load monitoring. Enhanced resistance monitoring is warranted in Africa.

Original languageEnglish
Pages (from-to)19-26
Number of pages8
JournalCurrent Opinion in HIV and AIDS
Volume8
Issue number1
DOIs
Publication statusPublished - 1 Jan 2013

Cite this

Hamers, Raph L. ; Sigaloff, Kim C E ; Kityo, Cissy ; Mugyenyi, Peter ; De Wit, Tobias F Rinke. / Emerging HIV-1 drug resistance after roll-out of antiretroviral therapy in sub-Saharan Africa. In: Current Opinion in HIV and AIDS. 2013 ; Vol. 8, No. 1. pp. 19-26.
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Emerging HIV-1 drug resistance after roll-out of antiretroviral therapy in sub-Saharan Africa. / Hamers, Raph L.; Sigaloff, Kim C E; Kityo, Cissy; Mugyenyi, Peter; De Wit, Tobias F Rinke.

In: Current Opinion in HIV and AIDS, Vol. 8, No. 1, 01.01.2013, p. 19-26.

Research output: Contribution to journalReview articleAcademicpeer-review

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