The prevalence of resistance to nonnucleoside reverse transcriptase inhibitors among HIV-infected individuals has increased to ‘alarming levels’ in Aruba, reaching 45% in 2015, researchers reported.
L. Marije Hofstra, MD, of the department of medical microbiology at the University Medical Center Utrecht, the Netherlands, and colleagues discovered that the increase in resistance is due to a rise in the nonnucleoside reverse transcriptase inhibitor (NNRTI)-mutation K103N. The mutation has a detrimental effect against Sustiva (efavirenz, Bristol-Myers Squibb) and nevirapine, which are commonly used in first-line combination ART (cART) regimens in high-endemic countries.
“Emergence of HIV drug resistance during cART use has tremendously decreased in Western countries, and transmission of drug resistance has merely stabilized in recent years, as a result of close laboratory monitoring, the use of regimens with a higher genetic barrier to resistance, and surveillance,” Hofstra, who also is fromthe department of infection and immunity at Luxembourg Institute of Health, and colleagues wrote in Clinical Infectious Diseases. “However, our data demonstrate that in a setting without adequate surveillance, the prevalence of infections with NNRTI-resistant HIV can increase to worrisome levels, compromising the efficacy of the standard first-line NNRTI-based regimen.”
The researchers examined data on 104 treatment-naive participants who underwent HIV drug-resistance testing from 2010 to 2015 in Aruba. Among them, 86% were men, 39% were foreign-born and 22% had AIDS at diagnosis.