Author: Tulio de Oliveira - 2014-01-16

Tweet

Yesterday I presented an AIDSReviews paper on HIV Drug Resistance in Africa (Lessells, Avalos & de Oliveira, 2013) at the Africa Centre Scientific Seminar (3pm to 4pm South Africa time) in Mtubatuba, South Africa.

For the sake of interaction with the greater community, we decided to circulate the paper on twitter and ask for questions. We asked for Internet users to identify their questions with the HashTag: #HIVDRAfrica. We had received and answered many interesting questions. We had fun answering the questions and interacting with our audience!

We whould like to thank our twitter participants! @jienchi, @frickjifang, @tomayates, @AvaAvalos, @DeenanDpillay & @rjlessells

Q1:

Jienchi Dorward @jienchi Jan 15 - @drug_resistance #HIVDRAfrica Patients switched TDF/3TC/EFV to TDF despite high VL: which regimen 1. while sorting adherence 2. 2nd line

SATuRN @drug_resistance - @jienchi continue while sorting adherence then switch to AZT/3TC/LPVr but good example of where resistance testing useful

SATuRN @drug_resistance - @jienchi patient risk of having lost TDF through K65R so AZT may be safer option. Depends how long failing each regimen really.

Q2:

Jienchi Dorward @jienchi - @drug_resistance Any data on how long it takes to get K65R if failing on TDF

SATuRN @drug_resistance - @jienchi it's a difficult one but sadly common as we know. See case 4 in the book http://www.bioafrica.net/cases.phpid=4

Q3:

frickjifang @frickjifang - #HIVDRAfrica possible to switch single drug in 2nd line ARVs regimens provided undetectable viral load and no mutation to the new drug

Ava Avalos @AvaAvalos - @frickjifang Yes it fine to switch a single drug if the VL is undetectable.

frickjifang @frickjifang - @AvaAvalos Thank you for ur answer!

Q4:

Tom Yates @tomayates - #HIVDRAfrica @drug_resistance is there any reason POC resistance testing can't be developed using XPERT platform Is anyone looking at this

SATuRN @drug_resistance - @tomayates Yes i think cepheid and partners have been working on that while developing xpert viral load assay - don't know details though

Q5:

Tom Yates @tomayates Jan 15 - #HIVDRAfrica @drug_resistance is it possible to do viral loads on dried blood spots

Ava Avalos @AvaAvalos - @tomayates @drug_resistance Yes, we do dbs for children in Botswana regularly.

Q6:

Tom Yates @tomayates Jan 15 - #HIVDRAfrica @drug_resistance Should we put something inert and v slowly metabolised in ARVs to allow us to assay adherence Silly thought

SATuRN @drug_resistance - @tomayates Not silly. Spent some time thinking about this couple of yrs back. People already on case - will send link later.

SATuRN @drug_resistance - @tomayates problem though is regulatory as it would then be new drug/formulation

Q7:

Tom Yates @tomayates Jan 15 - #HIVDRAfrica @drug_resistance is there any reason ARVs can't be given using an implanon type device, as we do with hormonal contraception

SATuRN @drug_resistance - @tomayates no reason - there is development of long-acting depot ARVs but none made it to market yet

Tom Yates @tomayates - @drug_resistance I'd be more worried about that. If there are side effects, harder to remove depot than an implant.

Deenan Pillay @DeenanDpillay - @tomayates @drug_resistance of interest to at least one company I know

Q8:

Deenan Pillay @DeenanDpillay 15 Jan - @drug_resistance isn't evidence needed for clinical utility of testing

SATuRN @drug_resistance - @DeenanDpillay yes absolutely - how do you think we should gather the evidence We need to define the research questions

Q9:

Jienchi Dorward @jienchi 15 Jan - @drug_resistance #HIVDRAfrica Kids<35kg failing d4T/3TC/EFV. No Paeds TDF. SADoH say AZT/ABC/LPVr. Why no 3TC WHO say ABC/3TC/LPVr. Advice

SATuRN @drug_resistance - @jienchi Stick with SA guidelines but we need more evidence to inform treatment strategies for kids.

General comments:

Jienchi Dorward @jienchi Jan 15 - @drug_resistance #HIVDRAfrica That's it for now. Wish could be there! And that could do one of your Phds!! :)

Tom Yates @tomayates Jan 15 - HIVDRAfrica @drug_resistance that was fun, thanks!

frickjifang @frickjifang - @AvaAvalos Thank you for ur answer!

Links: