High rates of tenofovir failure in a CRF01_AE-predominant HIV epidemic in the Philippines. (June 2020)

• Record Type: Journal Article
• Authors: Salvana, Edsel Maurice T.; Samonte, Genesis May J.; Telan, Elizabeth; Leyritana, Katerina; Tactacan-Abrenica, Rosario Jessica; Ching, Patrick R.; Arevalo, Geraldine M.; Dungca, Niña Theresa; Peñalosa-Ramos, Christine; Mendoza, Kevin Anthony R.; Trinidad, Lyka F.; Tonga, Angelo dela; Lim, Jodor; Destura, Raul; Alejandria, Marissa; Solante, Rontgene; Arcangel, Lalaine; Palaypayon, Noel S.; Schwem, Brian E.
• Is Part Of: International journal of infectious diseases. Volume 95(2020)
• Page Start: 125
• Page End: 132
• Publication Date: 2020-06
• Subjects: HIV -- Philippines -- Drug resistance -- K65R; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2020.02.020
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: Our study is the first systematic acquired drug resistance surveillance of HIV patients from the Philippines, which currently has one of the fastest growing epidemics in the world. We found high rates of tenofovir and multidrug resistance compared to other HIV resistance studies and other subtypes. These results are important and will be interesting to the HIV research community as they are from an unusual epidemic that switched from a predominant subtype B to CRF01_AE. Abstract: Background: The Philippines has the fastest growing HIV epidemic in the Asia-Pacific. This increase was accompanied by a shift in the predominant HIV subtype from B to CRF01_AE. Increasing evidence points to a difference in treatment responses between subtypes. We examined treatment failure and acquired drug resistance (ADR) in people living with HIV (PLHIVs) after one year on antiretrovirals (ARVs). Methods: PLHIV maintained on ARVs for one year were recruited. Treatment failure was defined as a viral load of ≥1000 copies/mL. Sanger sequencing for genotyping and drug resistance mutation (DRM) detection was performed on patients failing treatment. Results: 513 PLHIV were enrolled. The most common antiretroviral regimens were TDF+3TC + EFV (269) and AZT+3TC + EFV (155). 53 (10.3%) subjects failed treatment. Among these, 48 (90.6%) had DRMs, 84.9% were subtype CRF01_AE. Tenofovir-based regimens performed worse than zidovudine-based regimens (OR 3.28, 95% CI 1.58–7.52 p < 0.001). Higher rates of NRTI, NNRTI, K65R tenofovir resistance, and multi-class resistance were found compared to those reported in literature. Conclusions: HIV treatment failure at one year of treatment in the Philippines is 10.3%. We found unusually high tenofovir and multiclass resistance, and optimal ARV regimens may need to be reevaluated for CRF01_AE-predominant epidemics.