Abstract
About 22 million people globally received antiretroviral therapy (ART) in 2017. 1 UNAIDSMiles to go. Closing gaps, breaking barriers, righting injustices. Joint United Nations Programme on HIV/AIDS, Geneva2018 Google Scholar In patients on ART, viral suppression is crucial for both the individual patient's clinical benefit and the community's HIV prevention benefit. A key reason for failure to achieve viral suppression is resistance to one or more drugs in the patient's antiretroviral regimen. Maintenance of a strict daily pill regimen can be challenging for patients; suboptimal adherence fosters drug resistance and the transmission of drug-resistant strains of HIV to others. Furthermore, resistance to non-nucleoside reverse transcriptase inhibitors (NNRTls) is widespread, emanating from previous use of nevirapine as a single drug regimen for prevention of mother-to child transmission. 2 Gupta RK Gregson J Parkin N et al. HIV-1 drug resistance before initiation or re-initiation of first-line antiretroviral therapy in low-income and middle-income countries: a systematic review and meta-regression analysis. Lancet Infect Dis. 2018; 18: 346-355 Summary Full Text Full Text PDF PubMed Scopus (228) Google Scholar Clinically relevant thresholds for ultrasensitive HIV drug resistance testing: a multi-country nested case-control studyUltrasensitive resistance testing for pretreatment drug resistance improved identification of people at risk of virological failure; however, this came with a reduction in our ability to identify people with viral suppression, especially at very low thresholds. Further modelling is needed to estimate the optimal trade-off for the 5% and 20% thresholds, balancing improved case finding against unnecessary regimen switching. Full-Text PDF
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