title: Update on HIV-1 acquired and transmitted drug resistance in Africa.
abstract: The last ten years have witnessed a significant scale-up and access to antiretroviral therapy in Africa, which has improved patient quality of life and survival. One major challenge associated with increased access to antiretroviral therapy is the development of antiretroviral resistance due to inconsistent drug supply and/or poor patient adherence. We review the current state of both acquired and transmitted drug resistance in Africa over the past ten years (2001-2011) to identify drug resistance associated with the different drug regimens used on the continent and to help guide affordable strategies for drug resistance surveillance. A total of 161 references (153 articles, six reports and two conference abstracts) were reviewed. Antiretroviral resistance data was available for 40 of 53 African countries. A total of 5,541 adult patients from 99 studies in Africa were included in this analysis. The pooled prevalence of drug resistance mutations in Africa was 10.6%, and Central Africa had the highest prevalence of 54.9%. The highest prevalence of nucleoside reverse transcriptase inhibitor mutations was in the west (55.3%) and central (54.8%) areas; nonnucleoside reverse transcriptase inhibitor mutations were highest in East Africa (57.0%) and protease inhibitors mutations highest in Southern Africa (16.3%). The major nucleoside reverse transcriptase inhibitor mutation in all four African regions was M184V. Major nonnucleoside reverse transcriptase inhibitor as well as protease inhibitor mutations varied by region. The prevalence of drug resistance has remained low in several African countries although the emergence of drug resistance mutations varied across countries. Continued surveillance of antiretroviral therapy resistance remains crucial in gauging the effectiveness of country antiretroviral therapy programs and strategizing on effective and affordable strategies for successful treatment.
authors.affiliation: MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda.
authors.forename: Deogratius
authors.initials: D
authors.lastname: Ssemwanga
authors.affiliation: Center for Virus Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.
authors.forename: Raphael W
authors.initials: RW
authors.lastname: Lihana
authors.affiliation: Institute of Human Virology (IHV)-Nigeria, Abuja, Nigeria.
authors.forename: Chinenye
authors.initials: C
authors.lastname: Ugoji
authors.affiliation: Institute of Human Virology (IHV)-Nigeria, Abuja, Nigeria; Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA.
authors.forename: Alash'le
authors.initials: A
authors.lastname: Abimiku
authors.affiliation: US Centre for Disease Control and Prevention, Division of Global HIV/AIDS, International Laboratory Branch, Atlanta, USA.
authors.forename: John
authors.initials: J
authors.lastname: Nkengasong
authors.affiliation: Institute of Human Virology (IHV)-Nigeria, Abuja, Nigeria.
authors.forename: Patrick
authors.initials: P
authors.lastname: Dakum
authors.affiliation: Institute of Human Virology (IHV)-Nigeria, Abuja, Nigeria.
authors.forename: Nicaise
authors.initials: N
authors.lastname: Ndembi
mesh_terms: D000349:Africa / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D024882:Drug Resistance, Viral / Q000235:genetics*; D005838:Genotype; D015658:HIV Infections / Q000188:drug therapy*; D015497:HIV-1 / Q000187:drug effects*; D006801:Humans; D009154:Mutation / Q000235:genetics; D015995:Prevalence; D011634:Public Health; D011788:Quality of Life; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D018571:Sentinel Surveillance
chemical_list: D019380:Anti-HIV Agents; D018894:Reverse Transcriptase Inhibitors