title: Do HIV-1 non-B subtypes differentially impact resistance mutations and clinical disease progression in treated populations? Evidence from a systematic review.
abstract: There are 31 million adults living with HIV-1 non-B subtypes globally, and about 10 million are on antiretroviral therapy (ART). Global evidence to guide clinical practice on ART response in HIV-1 non-B subtypes remains limited. We systematically searched 11 databases for the period 1996 to 2013 for evidence. Outcomes documented included time to development of AIDS and/or death, resistance mutations, opportunistic infections, and changes in CD4 cell counts and viral load. A lack of consistent reporting of all clinical end points precluded a meta-analysis. In sum, genetic diversity that precipitated differences in disease progression in ART-naïve populations was minimized in ART-experienced populations, although variability in resistance mutations persisted across non-B subtypes. To improve the quality of patient care in global settings, recording HIV genotypes at baseline and at virologic failure with targeted non-B subtype-based point-of-care resistance assays and timely phasing out of resistance-inducing ART regimens is recommended.
authors.affiliation: Division of Clinical Epidemiology & Infectious Diseases, McGill University Health Centre, Montreal, Canada.
authors.forename: Madhavi
authors.initials: M
authors.lastname: Bhargava
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Queen's University, Kingston, Canada.
authors.forename: Jorge Martinez
authors.initials: JM
authors.lastname: Cajas
authors.affiliation: Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, Canada.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Wainberg
authors.affiliation: Chronic Viral Illness Service, Division of Infectious Diseases & Clinical Epidemiology, Department of Medicine, McGill University and McGill University Health Centre, Montreal, Canada.
authors.forename: Marina B
authors.initials: MB
authors.lastname: Klein
authors.affiliation: Division of Clinical Epidemiology & Infectious Diseases, McGill University Health Centre, Montreal, Canada; Department of Medicine, McGill University, Montreal, Canada; nitika.pai@mcgill.ca.
authors.forename: Nitika
authors.initials: N
authors.lastname: Pant Pai
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018450:Disease Progression; D024882:Drug Resistance, Viral / Q000235:genetics; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics; D006801:Humans; D009154:Mutation / Q000235:genetics; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents
keywords: HIV-1; differential impact; disease progression; evidence; non-B subtypes; resistance mutation; systematic review