Abstract
In response to increasing pretreatment drug resistance (PDR), Mexico changed its national antiretroviral treatment (ART) policy, recommending and procuring second-generation integrase strand-transfer inhibitor (INSTI)-based regimens as preferred first-line options since 2019. We present a four-year observational study describing PDR trends across 2017–2020 at the largest HIV diagnosis and primary care center in Mexico City. A total of 6688 baseline protease-reverse transcriptase and 6709 integrase sequences were included. PDR to any drug class was 14.4% (95% CI, 13.6–15.3%). A significant increasing trend for efavirenz/nevirapine PDR was observed (10.3 to 13.6%, p = 0.02). No increase in PDR to second-generation INSTI was observed, remaining under 0.3% across the study period. PDR was strongly associated with prior exposure to ART (aOR: 2.9, 95% CI: 1.9–4.6, p < 0.0001). MSM had higher odds of PDR to efavirenz/nevirapine (aOR: 2.0, 95% CI: 1.0–3.7, p = 0.04), reflecting ongoing transmission of mutations such as K103NS and E138A. ART restarters showed higher representation of cisgender women and injectable drug users, higher age, and lower education level. PDR to dolutegravir/bictegravir remained low in Mexico City, although further surveillance is warranted given the short time of ART optimization. Our study identifies demographic characteristics of groups with higher risk of PDR and lost to follow-up, which may be useful to design differentiated interventions locally.
Highlights
Antiretroviral therapy (ART) has provided undeniable benefits at the individual and population levels, significantly reducing morbidity and mortality among people living with HIV (PLVIH) [1] and averting new infections [2]
The high nucleoside reverse transcriptase inhibitors (NNRTIs) pretreatment drug resistance (PDR) levels observed have led to the World Health Organization (WHO) recommendation and advocacy of the use of dolutegravir-based first-line regimens as the preferred option in low- and middleincome countries (LMICs) [7]
Given the high genetic barrier of second-generation integrase strand-transfer inhibitor (INSTI)-based ART regimens [13], as well as the low impact of baseline DRMs observed in the nucleoside reverse transcriptase inhibitor (NRTI) backbone in the effectiveness of these regimens [14], HIV PDR surveillance has become less of a priority in regions widely using dolutegravir and bictegravir
Summary
Antiretroviral therapy (ART) has provided undeniable benefits at the individual and population levels, significantly reducing morbidity and mortality among people living with HIV (PLVIH) [1] and averting new infections [2]. The widespread use of ART has been associated with the rise and spread of HIV drug resistance (HIVDR) [4]. According to the World Health Organization (WHO) operational definition, pretreatment drug resistance (PDR) refers to HIVDR detected in ART-naïve persons or previously antiretroviral (ARV)-exposed persons reinitiating first-line ART [5]. There is growing evidence that PDR to non-nucleoside reverse transcriptase inhibitors (NNRTIs), mainly efavirenz and nevirapine, has been increasing in low- and middleincome countries (LMICs) [6]. Nationally representative surveys have been performed in several LMICs evidencing efavirenz/nevirapine PDR levels over 10% [4]. The high NNRTI PDR levels observed have led to the WHO recommendation and advocacy of the use of dolutegravir-based first-line regimens as the preferred option in LMICs [7]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
