Antiretroviral Drug Resistance- implications for HIV/AIDS reduction in Sub-Saharan Africa and other developing countries

Malaria has been a major epidemic that has ravaged millions predominantly in the developing countries of the world with variability in symptoms, causative agents and use of chemotherapy or vector control as preventive measures. Malaria transmission occurs primarily in tropical and subtropical regions in the sub-Saharan Africa, Central and South America. Currently, malaria diagnosis rests mainly on the microscopic detection of parasites in blood samples or rapid diagnostic test (RDT). Preventing drug resistance involves orientation programmes, identification of new treatment modalities, artemisinin (ACT) etc. Treatment failures has been reported for these ACTs leading to an urgency in the need for further novel discoveries and advances in the fight against this menance (antimalarial drug resistance) in developing countries of the world. Understanding the mechanism of action of the antimalarial drugs and most significantly, monitoring the drug resistance to the available antimalarial drugs via regular molecular investigations of resistant markers would definitely aid implementation of effective drug policy.

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Drug resistance in HIV-positive adults during the initial year of antiretroviral treatment at Ethiopian health centers

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab106 ◽

2021 ◽

Author(s):

Anton Reepalu ◽

Dawit A Arimide ◽

Taye T Balcha ◽

Habtamu Yeba ◽

Adinew Zewdu ◽

...

Keyword(s):

Drug Resistance ◽

Antiretroviral Treatment ◽

Health Centers ◽

Sub Saharan Africa ◽

Hiv Positive ◽

Antiretroviral Drug Resistance ◽

Antiretroviral Drug ◽

Increased Risk ◽

Hiv Positive Adults ◽

The Impact

Abstract Objectives The increasing prevalence of antiretroviral drug resistance in sub-Saharan Africa threatens the success of HIV programs. We have characterized patterns of drug resistance mutations (DRM) during the initial year of antiretroviral treatment (ART) in HIV-positive adults receiving care at Ethiopian health centers and investigated the impact of tuberculosis on DRM acquisition. Methods Participants were identified from a cohort of ART-naïve individuals aged ≥18 years, all of whom had been investigated for active tuberculosis at inclusion. Individuals with viral load (VL) data at 6 and/or 12 months after ART initiation were selected for this study. Genotypic testing was performed on samples with VL≥500 copies/mL obtained on these occasions, and on pre-ART samples from those with detectable DRM during ART. Logistic regression analysis was used to investigate the association between DRM acquisition and tuberculosis. Results Among 621 included individuals (110 [17.5%] with concomitant tuberculosis), 101/621 (16.3%) had VL≥500 copies/mL at 6 and/or 12 months. DRM were detected in 64/98 cases with successful genotyping (65.3%). DRM were detected in 7/56 (12.5%) pre-ART samples from these individuals. High pre-ART VL and low mid-upper arm circumference were associated with increased risk of DRM acquisition, whereas no such association was found for concomitant tuberculosis. Conclusions Among adults receiving health-center based ART in Ethiopia, most patients without virological suppression during the first year of ART had detectable DRM. Acquisition of DRM during this period was the dominant cause of antiretroviral drug resistance in this setting. Tuberculosis did not increase the risk of DRM acquisition.

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