title: HIV drug resistance (HIVDR) in antiretroviral therapy-naïve patients in Tanzania not eligible for WHO threshold HIVDR survey is dramatically high.
abstract: BACKGROUND
  The World Health Organization (WHO) has recommended guidelines for a HIV drug resistance (HIVDR) survey for resource-limited countries. Eligibility criteria for patients include age below 25 years in order to focus on the prevalence of transmitted HIVDR (tHIVDR) in newly-infected individuals. Most of the participating sites across Africa have so far reported tHIVDR prevalences of below 5%. In this study we investigated whether the rate of HIVDR in patients <25 years is representative for HIVDR in the rest of the therapy-naïve population.
  
  
  RESULTS
  HIVDR was determined in 88 sequentially enrolled ART-naïve patients from Mwanza, Tanzania (mean age 35.4 years). Twenty patients were aged <25 years and 68 patients were aged 25-63 years. The frequency of HIVDR in the study population was 14.8% (95%; CI 0.072-0.223) and independent of NVP-resistance induced by prevention of mother-to-child transmission programs. Patients >25 years had a significantly higher HIVDR frequency than younger patients (19.1%; 95% CI 0.095-0.28) versus 0%, P = 0.0344). In 2 out of the 16 patients with HIVDR we found traces of antiretrovirals (ARVs) in plasma.
  
  
  CONCLUSIONS
  ART-naïve patients aged over 25 years exhibited significantly higher HIVDR than younger patients. Detection of traces of ARVs in individuals with HIVDR suggests that besides transmission, undisclosed misuse of ARVs may constitute a significant factor in the generation of the observed high HIVDR rate. The current WHO tHIVDR survey that is solely focused on the transmission of HIVDR and that excludes patients over 25 years of age may therefore result in substantial underestimation of the prevalence of HIVDR in the therapy-naïve population. Similar studies should be performed also in other areas to test whether the so far reported optimistic picture of low HIVDR prevalence in young individuals is really representative for the rest of the ART-naïve HIV-infected population.
authors: Institute of Virology and Immunobiology, University of Würzburg, Würzburg, Germany.
authors: Christa
authors: C
authors: Kasang
authors: Samuel
authors: S
authors: Kalluvya
authors: Charles
authors: C
authors: Majinge
authors: August
authors: A
authors: Stich
authors: Jochen
authors: J
authors: Bodem
authors: Gilbert
authors: G
authors: Kongola
authors: Graeme B
authors: GB
authors: Jacobs
authors: Mathias
authors: M
authors: Mlewa
authors: Miriam
authors: M
authors: Mildner
authors: Irina
authors: I
authors: Hensel
authors: Anne
authors: A
authors: Horn
authors: Wolfgang
authors: W
authors: Preiser
authors: Gert
authors: G
authors: van Zyl
authors: Hartwig
authors: H
authors: Klinker
authors: Eleni
authors: E
authors: Koutsilieri
authors: Axel
authors: A
authors: Rethwilm
authors: Carsten
authors: C
authors: Scheller
authors: Benedikt
authors: B
authors: Weissbrich
mesh_terms: D000328:Adult; D000375:Aging; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D003710:Demography; D016903:Drug Monitoring; D024882:Drug Resistance, Viral; D004608:Eligibility Determination / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000635:transmission / Q000821:virology; D015497:HIV-1 / Q000145:classification / Q000235:genetics; D019538:Health Care Surveys / Q000706:statistics & numerical data*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D009154:Mutation / Q000235:genetics; D010802:Phylogeny; D013636:Tanzania / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D014944:World Health Organization; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents