Perspective: Extreme high-level of drug resistance in Aruba: We need ITI-based regimens available globally now!

Healio News: IAS Perspective - 2017-03-17

Perspective by Carlos del Rio, MD Professor of medicine, division of infectious diseases, Emory University School of Medicine on our recent CID manuscript on high-level transmitted resistance epidemic in Aruba.


Click on the image to access our CID publication

The major issue related to drug resistance in most of the world is that the most commonly used regimen contains efavirenz, and in many places (especially in Los Angeles), it is not available as a fixed dose combination, so people may not take their efavirenz. The findings in this study in Aruba show a large increase in the prevalence of K103N mutations from 2010 to 2015. But even the prevalence at 26% in 2010 is alarmingly high, so my question is, what did they do then? How did they act based on these data? The study sample is small and I suspect that all new diagnoses did not get baseline resistance testing (which is the case in most of the world). A major implication is that if we lose EFV, we are in trouble starting an EFV?containing regimen in most of the world where genotypic testing is not routinely available. Bottom line: we need ITI-based regimens available globally now.

Carlos del Rio, MD

Professor of medicine, division of infectious diseases, Emory University School of Medicine

Immediate past chair, HIV Medicine Association

Disclosure: del Rio reports being a member of the board of the HIV Medicine Association and International Antiviral Society-USA, and chair of the PEPFAR Scientific Advisory Board.

Links:

http://www.healio.com/infectious-disease/hiv-aids/news/in-the-journals/%7B17e947c4-87d8-488d-a874-b58d9a0bfb27%7D/prevalence-of-drug-resistant-hiv-reaches-alarming-levels-in-aruba

KRISP News: Perspective: Extreme high-level of drug resistance in Aruba: We need ITI-based regimens available globally now!
Publication cited

High Rates of Transmission of Drug-resistant HIV in Aruba Resulting in Reduced Susceptibility to the WHO Recommended First-line Regimen in Nearly Half of Newly Diagnosed HIV-infected Patients. Hofstra LM, Rivas ES, Nijhuis M, Bank LEA, Wilkinson E, Kelly K, Mudrikova T, Schuurman R, de Oliveira T, de Kort J, Wensing AMJ, Clinical Infectious Diseases (2017), :doi: 10.1093/cid/cix056.