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Abstract
BackgroundHIV transmitted drug resistance (TDR) remains at moderate level in Latin America and the Caribbean (LAC). However, different epidemiologic scenarios could influence national and sub-regional TDR levels and trends.Methods and FindingsWe performed a systematic review of currently available publications on TDR in antiretroviral treatment-naïve adults in LAC. Ninety-eight studies published between January 2000 and June 2015 were included according to critical appraisal criteria and classified by sub-region: Brazil (50), Mesoamerica (17), Southern Cone (16), Andean (8) and Caribbean (7). From these, 81 studies encompassing 11,441 individuals with data on DR mutation frequency were included in a meta-analysis. Overall TDR prevalence in LAC was 7.7% (95% CI: 7.2%-8.2%). An increasing trend was observed for overall TDR when comparing 2000–2005 (6.0%) and 2006–2015 (8.2%) (p<0.0001), which was associated with significant NNRTI TDR increase (p<0.0001). NRTI TDR decreased (4.5% vs. 2.3%, p<0.0001). NNRTI TDR increase was associated mainly with K101E, K103N and G190A. NRTI TDR decrease was associated mainly with M184V, K70R and T215Y. All sub-regions reached moderate overall TDR levels. The rapid increase in TDR to all antiretroviral classes in the Caribbean is notable, as well as the significant increase in NNRTI TDR reaching moderate levels in the Southern Cone. NRTI TDR was dominant in 2000–2005, mainly in the Caribbean, Mesoamerica and Brazil. This dominance was lost in 2006–2015 in all sub-regions, with the Southern Cone and the Caribbean switching to NNRTI dominance. PI TDR remained mostly constant with a significant increase only observed in the Caribbean.ConclusionsGiven the high conceptual and methodological heterogeneity of HIV TDR studies, implementation of surveys with standardized methodology and national representativeness is warranted to generate reliable to inform public health policies. The observed increasing trend in NNRTI TDR supports the need to strengthen TDR surveillance and programme monitoring and evaluation in LAC.
Highlights
Latin America and the Caribbean (LAC) has some of the oldest national universal access antiretroviral treatment (ART) programs among low- and middle-income countries (Brazil, Argentina, Mexico, Chile, Costa Rica to name a few), and many of these programs introduced access to mono- and dual therapies in the 90’s
The World Health Organization (WHO) recently published an early-release guideline recommending that ART should be initiated in everyone living with HIV at any CD4 cell count and number of people initiating ART in future years is expected to increase [2]
This study was later expanded to 401 participants, including samples from 2007–2011 observing a significant increase in transmitted drug resistance (TDR) in recently infected individuals compared to 2003 (14.8 vs. 3.8%; OR 3.9, 95% CI 1.5–17.0, p = 0.02)
Summary
LAC has some of the oldest national universal access antiretroviral treatment (ART) programs among low- and middle-income countries (Brazil, Argentina, Mexico, Chile, Costa Rica to name a few), and many of these programs introduced access to mono- and dual therapies in the 90’s. Treatment 2.0 has supported the adoption of a public health approach to HIV care and treatment, aiming at improving the effectiveness and sustainability of the response towards the post-2015 Fast-Track targets, in particular the so-called “90-90-90” [4,5,6]. Problems such as recurring stock-outs of antiretroviral (ARV) drugs, late detection of HIV infection, gaps in linkage and retention in care, and suboptimal retention in care and viral suppression on ART are observed in many LAC countries [7, 8].
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