alexa HIV Drug Resistance Patterns at the Epicentre of the HIV-1 Epidemic in Kwazulu-Natal, South Africa 2003-2013
ISSN 2155-6113

Journal of AIDS & Clinical Research
Open Access

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Review Article

HIV Drug Resistance Patterns at the Epicentre of the HIV-1 Epidemic in Kwazulu-Natal, South Africa 2003-2013

Photini Kiepiela1*, Justen Manasa2*, Mahomed-Yunus Moosa3, Pravi Moodley4, Michelle Gordon5, Urvi M Parikh6, Henry Sunpath7, Tulio de Oliveira2 and Gita Ramjee1

1HIV Prevention Research Unit, Medical Research Council, 123 Jan Hofmeyr Road, Westville 3630, Durban, South Africa

2Africa Centre for Health and Population Studies, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

3Department of Infectious Diseases, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

4Department of Virology, National Health Laboratory Service / University of KwaZulu-Natal, Durban, South Africa

5HIV Pathogenesis Programme, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

6Department of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

7Sinikithemba, McCord Hospital, Durban, South Africa

*Corresponding Author:
Photini Kiepiela
HIV Prevention Research Unit
Medical Research Council
123 Jan Hofmeyr Road
Westville 3630, Durban, South Africa
Tel: +27 312423656
Fax: +27 312423800
E-mail: [email protected]

Justen Manasa
Africa Centre for Health and Population Studies
College of Health Sciences, University of KwaZulu-Natal
Durban, South Africa
E-mail: [email protected]

Received Date: February 17, 2014; Accepted Date: April 15, 2014; Published Date: April 25, 2014

Citation: Kiepiela P, Manasa J, Moosa MY, Moodley P, Gordon M, et al. (2014) HIV Drug Resistance Patterns at the Epicentre of the HIV-1 Epidemic in Kwazulu-Natal, South Africa 2003-2013. J AIDS Clin Res 5:299. doi:10.4172/2155-6113.1000299

Copyright: © 2014 Kiepiela P, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

 

Abstract

South Africa has the highest number of individuals with HIV-1 infection worldwide with the epicentre of the epidemic in the province of KwaZulu-Natal (KZN). Currently South Africa has the largest antiretroviral treatment (ART) programme with KZN and Gauteng provinces accounting for 56% of all patients on ART. In order to understand transmission dynamics and temporal trends in drug resistance, we performed a comprehensive literature review of primary and acquired drug resistance in adults and children in KZN over a ten year period, 2003-2013. Transmitted drug resistance (TDR) to non-nucleoside reverse transcriptase inhibitors (NNRTIs) in adults is increasing to moderate levels (5-15%). Acquired drug resistance to first line drug regimens in adults was associated with at least one mutation to nucleoside reverse transcriptase inhibitors (NRTI) or NNRTIs or both, with M184V and K103N the most common mutations. Prevalence of thymidine analogues (TAMs) was low to moderate. There was no published data on acquired drug resistance to second line agents. Children failing first line drug regimens harboured drug resistance mutations to NRTI (M184V and TAMs), NNRTI (V106M and K103N) and protease inhibitors (PIs) (V82A). Concerns have been raised about the high levels of the K65R mutation associated with tenofovir regimens in adults and children. Continued vigilance is needed for ART failure in both adults and children, so as not to compromise second line treatment options. Drug resistance genotyping is now cost effective and should be considered for inclusion in regional surveillance studies and during routine care.

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