Study highlights need to test patients for antiretroviral resistance in resource-limited settings as well as in wealthy ones

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Study also finds HIV subtype most common in Africa progresses the fastest

CID515A multinational study has spelled out two ways the cards are stacked against those living with the virus in the countries where rates of HIV are highest, with greater risks of treatment failing to suppress the virus.

Findings from the PEARLS study, released this week in Clinical Infectious Diseases, looked at the role of viral subtype in disease progression. It also looked at the role of viral resistance to medicines used to suppress the virus in treatment failure. Researchers found that even with the same treatment, the disease progresses faster in people infected with subtype C, the subtype most commonly found in southern Africa and India, and the subtype that causes more than half of all infections worldwide. In addition, they confirmed that people infected with viruses that already were resistant to antiretroviral drugs had lower chances that treatment would work. And yet, the report on the study notes, while testing individuals for signs their virus is resistant to some medicines is recommended and routine in wealthy countries, in countries with more limited resources, it is not. Instead, the World Health Organization guidelines suggest monitoring transmitted drug resistance on a population level, to guide programmatic decisions. The authors of the report, led by Rami Kantor of Brown University’s Department of Medicine Division of Infectious Diseases, note the impact of transmitted drug resistance on treatment failure and urge  testing individuals in resource-limited settings for transmitted resistance before beginning treatment. The payoff of that testing will rise as the numbers of people on antiretroviral treatment, and with transmitted resistance to some drugs, continues to increase. In addition, an editorial by Mark Wainberg of McGill University AIDS Centre, accompanying the report urges incorporating the testing into routine practice in order to ensure the success of treatment. ” . . . in the event of a lack of funds, assistance programs sould be established to meet this need,” Wainberg writes.

While transmitted resistance was not associated more with one subtype than another, authors note that the faster disease progression and higher rates of treatment failure among people with subtype C warrant more research. The study is the first, they say, to support a link between subtype C with treatment failure. Wainberg notes in his commentary, that the findings point to the advisability of investigating links between subtypes and outcomes when developing new drugs.

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