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Primary drug resistance in South Africa
- data from 10 years of surveys
Manasa J, Katzenstein D, Cassol S, Newell
ML, de Oliveira T. Primary drug resistance
in South Africa - data from 10 years of
surveys AIDS Res Hum
Retroviruses,28(6):558-565 (2012).
Introduction
HIV-1 transmitted drug resistance (TDR) could
reverse the gains of antiretroviral rollout.
To ensure that current 1st line therapies remain
effective, TDR levels in recently infected
treatment-naive patients need to be monitored.
Reference: Manasa J, Katzenstein D, Cassol S, Newell ML, de Oliveira
T. Primary drug resistance in South Africa - data from 10 years of
surveys AIDS Res Hum Retroviruses,28(6):558-565 (2012).
Methods
A literature review and data mining exercise was carried
out to determine the temporal trends in TDR in South
Africa. In total 1,650 sequences were analyzed.
Publicly available data on TDR were retrieved from
Genbank, curated in RegaDB and analyzed using the
Calibrated Population Resistance Program.
Including, 72 sequences from seroconvertors identified
from Africa Centre's 2010 HIV surveillance round were
also examined for TDR.
Reference: Manasa J, Katzenstein D, Cassol S, Newell ML, de Oliveira
T. Primary drug resistance in South Africa - data from 10 years of
surveys AIDS Res Hum Retroviruses,28(6):558-565 (2012).
Table 1: Data from Nine Published Studies on Primary
Drug Resistance Using Inhouse Genotyping Methods on
Plasma Samples
Reference: Manasa J, Katzenstein D, Cassol S, Newell ML, de Oliveira
T. Primary drug resistance in South Africa - data from 10 years of
surveys AIDS Res Hum Retroviruses,28(6):558-565 (2012).
SATuRN - Surveillance of transmitted resistance
Data
Reference: Manasa J, Katzenstein D, Cassol S, Newell ML, de Oliveira
T. Primary drug resistance in South Africa - data from 10 years of
surveys AIDS Res Hum Retroviruses,28(6):558-565 (2012).
Figure 2 : Trend in the prevalence of transmitted drug
resistance between 2000 and 2010
Reference: Manasa J, Katzenstein D, Cassol S, Newell ML, de Oliveira
T. Primary drug resistance in South Africa - data from 10 years of
surveys AIDS Res Hum Retroviruses,28(6):558-565 (2012).
Figure 3 : HIV-1 drug resistance mutations identified in the
1,650 sequences used in the pooled analysis
Reference: Manasa J, Katzenstein D, Cassol S, Newell ML, de Oliveira
T. Primary drug resistance in South Africa - data from 10 years of
surveys AIDS Res Hum Retroviruses,28(6):558-565 (2012).
Extra Figure: Trend in HIV-1 Transmitted Drug Resistance
Levels Over Time.
10.00%
10.00%
Frequency
of mutations
Frequency
of mutations
7.50%
7.50%
5.00%
5.00%
2.50%
2.50%
0.00%
0.00%
before-2000
before-2000
2001-2002
2001-2002
2003-2004
2003-2004
2005-2006
2005-2006
2007-2009
2007-2009
YearYear
DR mutation
Any DR mutation Any NNRTI
NRTI
PI
Reference: Manasa J, Katzenstein D, Cassol S, Newell ML, de Oliveira
T. Primary drug resistance in South Africa - data from 10 years of
surveys AIDS Res Hum Retroviruses,28(6):558-565 (2012).
Conclusion
The prevalence of TDR in rural KZN is still very low, similar to reports from
other provinces of South Africa.
Although widespread resistance testing in South Africa is not recommended
at the present time, pretreatment genotypic testing has been shown to
significantly improve the outcome of first-line drug regimens in resource-rich
countries.
In Southern Africa as ART access and treatment programs grow, it is critical to
maintain surveillance among recent seroconverters and treatment-naive and
treated populations.
Programs covering well-defined geographic areas and populations minimize
the biases inherent in TDR surveillance and provide guidance in implementing
risk reduction and secondary prevention to maintain the effectiveness of firstline treatment.
Reference: Manasa J, Katzenstein D, Cassol S, Newell ML, de Oliveira
T. Primary drug resistance in South Africa - data from 10 years of
surveys AIDS Res Hum Retroviruses,28(6):558-565 (2012).
Open Access Article
Manasa J, Katzenstein D, Cassol S, Newell ML, de Oliveira
T. Primary drug resistance in South Africa - data from 10
years of surveys AIDS Res Hum Retroviruses,28(6):558-565
(2012).
http://www.bioafrica.net/publications.php?pubid=41
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Corresponding Author: Dr. Tulio de Oliveira
Email: [email protected]