Abstract
1report an increased likelihood of virological failure after the fi rst year of standard fi rst-line nonnucleoside transcriptase inhibitor-based antiretroviral therapy (ART) in patients who have a drug resistance mutation for at least one drug in the regimen. Moreover, they show that the risk of acquired HIV drug resistance is higher in people with pretreatment drug resistance than in those without. Although not entirely surprising, this study provides the fi rst documentation of this fi nding in an African setting. Policy makers should take note of these results in view of the rapid scale-up of ART in Africa, where few resources have been invested in optimum ART response-monitoring strategies (viral-load testing). 175 patients (7%) in the study population had drug resistance, this proportion is much the same as in other studies in resource-limited settings including Africa. 2 As ART is scaled up in Africa pretreatment resistance will increase. A study in Cameroon showed an association between ART scale-up and increased transmitted HIV drug resistance. 3 Therefore, I expect the study by Hamers and co-workers to become increasingly important as ART use in the region rises. The investigators—thanks to their meticulous methodology—make a compelling case for investment in pretreatment drug resistance testing in Africa, which should be done as more resources become available to ART programmes in the region. WHO recommends threshold surveys to monitor HIV drug resistance in resource-limited settings. 4
Published Version
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 call