title: Impact of human immunodeficiency virus type-1 sequence diversity on antiretroviral therapy outcomes.
abstract: Worldwide circulating HIV-1 genomes show extensive variation represented by different subtypes, polymorphisms and drug-resistant strains. Reports on the impact of sequence variation on antiretroviral therapy (ART) outcomes are mixed. In this review, we summarize relevant published data from both resource-rich and resource-limited countries in the last 10 years on the impact of HIV-1 sequence diversity on treatment outcomes. The prevalence of transmission of drug resistant mutations (DRMs) varies considerably, ranging from 0% to 27% worldwide. Factors such as geographic location, access and availability to ART, duration since inception of treatment programs, quality of care, risk-taking behaviors, mode of transmission, and viral subtype all dictate the prevalence in a particular geographical region. Although HIV-1 subtype may not be a good predictor of treatment outcome, review of emerging evidence supports the fact that HIV-1 genome sequence-resulting from natural polymorphisms or drug-associated mutations-matters when it comes to treatment outcomes. Therefore, continued surveillance of drug resistant variants in both treatment-naïve and treatment-experienced populations is needed to reduce the transmission of DRMs and to optimize the efficacy of the current ART armamentarium.
authors.affiliation: Department of Pediatrics, Yale University School of Medicine, 333 Cedar St, New Haven, CT 06520, USA. allison.Langs-barlow@yale.edu.
authors.forename: Allison
authors.initials: A
authors.lastname: Langs-Barlow
authors.affiliation: Departments of Pediatrics and Pharmacology, Yale University School of Medicine, Child Health Research Center, 464 Congress Ave, New Haven, CT 06520, USA. elijah.paintsil@yale.edu.
authors.forename: Elijah
authors.initials: E
authors.lastname: Paintsil
mesh_terms: D019380:Anti-HIV Agents / Q000494:pharmacology / Q000627:therapeutic use; D044966:Anti-Retroviral Agents / Q000494:pharmacology* / Q000627:therapeutic use; D024882:Drug Resistance, Viral / Q000235:genetics*; D014644:Genetic Variation; D015658:HIV Infections / Q000188:drug therapy / Q000635:transmission / Q000821:virology*; D015497:HIV-1 / Q000187:drug effects / Q000235:genetics*; D006801:Humans; D009154:Mutation; D015995:Prevalence; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents; D044966:Anti-Retroviral Agents