PUBLIC UTILITIES CODE 29034.6 TRIAL

We evaluated the association between PDR and the response to first-line ART (predominantly fixed-dose combination tenofovir/emtricitabine/efavirenz ) in individuals who initiated ART within the trial.

PUBLIC UTILITIES CODE 29034.6 TRIAL

Within the Treatment-as-Prevention (TasP) trial, a cluster-randomized trial undertaken in an HIV hyperepidemic setting in rural KwaZulu-Natal, South Africa, we estimated the prevalence of PDR using next-generation sequencing (NGS) technologies among HIV-positive participants who reported not to be on ART at entry into trial clinics. Fewer, generally smaller studies, that evaluated populations prescribed mainly older first-line ART regime, have not shown a similar association. Four of these studies accounted for ART adherence. The majority of studies in sub-Saharan Africa ( Supplementary Table 1) have shown a detrimental impact of pretreatment DR (PDR) on virological outcomes in individuals prescribed first-line ART mainly comprising a thymidine analogue backbone (zidovudine or stavudine combined with either efavirenz or nevirapine ). Despite the benefits of ART for individuals and populations, expanding ART access and longer time on therapy might increase emergence and transmission of drug resistance (DR), which could potentially compromise public ART programs in settings that use standardized first-line regimens. Human immunodeficiency virus (HIV) antiretroviral therapy (ART) scale-up in eastern and southern Africa has been a great success, with a doubling of the number of people on ART since 2010, reaching 10.3 million people in 2016, and with a 36% decline in the number of AIDS-related deaths.

( See the Editorial Commentary by Shafer and Frenkel on pages 215–7.)

HIV, pretreatment drug resistance, antiretroviral therapy, next-generation sequencing, virological response

Public utilities code 29034.6