Cambiano V., Bertagnolio S., Jordan M.R., Pillay D., Perriëns J.H., Venter F., Lundgren J., Phillips A.
Predicted levels of HIV drug resistance: Potential impact of expanding diagnosis, retention, and eligibility criteria for antiretroviral therapy initiation
Research Department of Infection and Population Health, UCL, Rowland Hill Street, London NW3 2PF, United Kingdom; World Health Organization, Geneva, Switzerland; Tufts University School of Medicine, Boston, MA, United States; Department of Infection, University College London, London, United Kingdom; Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa; Department of Infectious Disease, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
Cambiano, V., Research Department of Infection and Population Health, UCL, Rowland Hill Street, London NW3 2PF, United Kingdom; Bertagnolio, S., World Health Organization, Geneva, Switzerland; Jordan, M.R., Tufts University School of Medicine, Boston, MA, United States; Pillay, D., Department of Infection, University College London, London, United Kingdom; Perriëns, J.H., World Health Organization, Geneva, Switzerland; Venter, F., Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa; Lundgren, J., Department of Infectious Disease, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Phillips, A., Research Department of Infection and Population Health, UCL, Rowland Hill Street, London NW3 2PF, United Kingdom
BACKGROUND:: There is concern that the expansion of antiretroviral roll-out may impact future drug resistance levels and hence compromise the benefits of antiretroviral therapy (ART) at an individual and population level. We aimed to predict future drug resistance in South Africa and its long-term effects. METHODS:: The previously validated HIV Synthesis model was calibrated to South Africa. Resistance was modeled at the level of single mutations, transmission potential, persistence, and effect on drug activity. RESULTS:: We estimate 652 000 people (90% uncertainty range: 543 000-744 000) are living with nonnucleoside reverse transcriptase inhibitor (NNRTIs)-resistant virus in South Africa, 275 000 in majority virus [Non-nucleoside reverse transcriptase inhibitor resistant virus present in majority virus (NRMV)] with an unsuppressed viral load. If current diagnosis and retention in care and eligibility criteria are maintained, in 20 years' time HIV incidence is projected to have declined by 22% (95% confidence interval, CI -23 to -21%), and the number of people carrying NNRTI resistance to be 2.9-fold higher. If enhancements in diagnosis and retention in care occur, and ART is initiated at CD4 cell count less than 500 cells/μl, HIV incidence is projected to decline by 36% (95% CI: -37 to -36%) and the number of people with NNRTI resistance to be 4.1-fold higher than currently. Prevalence of people with viral load more than 500 copies/ml carrying NRMV is not projected to differ markedly according to future ART initiation policy, given the current level of diagnosis and retention are maintained. CONCLUSION:: Prevalence of resistance is projected to increase substantially. However, introduction of policies to increase ART coverage is not expected to lead to appreciably higher prevalence of HIV-positive people with resistance and viral load more than 500 copies/ml. Concern over resistance should not stop expansion of treatment availability.
nonnucleoside reverse transcriptase inhibitor; adolescent; adult; antiretroviral therapy; antiviral resistance; antiviral therapy; article; CD4 lymphocyte count; CD4+ T lymphocyte; disease course; drug activity; epidemic; health care policy; HIV test; human; Human immunodeficiency virus infection; Human immunodeficiency virus prevalence; incidence; infection prevention; major clinical study; mathematical model; middle aged; mortality; nonhuman; patient care; priority journal; sexual transmission; South Africa; virus load; virus mutation; virus resistance; virus transmission; young adult; Adolescent; Adult; Aged; Anti-Retroviral Agents; Antiretroviral Therapy, Highly Active; Drug Resistance, Viral; Drug Utilization; Female; HIV Infections; Humans; Male; Middle Aged; Models, Theoretical; Prevalence; South Africa; Young Adult