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Do HIV-1 non-B subtypes differentially impact resistance mutations and clinical disease progression in treated populations? Evidence from a systematic review

Madhavi Bhargava, Jorge Martinez Cajas, Mark A Wainberg, Marina B Klein, Nitika Pant Pai

Abstract


There are 31 million adults living with HIV-1 non-B subtypes globally, and about 10 million are on antiretroviral therapy (ART). Global evidence to guide clinical practice on ART response in HIV-1 non-B subtypes remains limited. We systematically searched 11 databases for the period 1996 to 2013 for evidence. Outcomes documented included time to development of AIDS and/or death, resistance mutations, opportunistic infections, and changes in CD4 cell counts and viral load. A lack of consistent reporting of all clinical end points precluded a meta-analysis. In sum, genetic diversity that precipitated differences in disease progression in ART-naïve populations was minimized in ART-experienced populations, although variability in resistance mutations persisted across non-B subtypes. To improve the quality of patient care in global settings, recording HIV genotypes at baseline and at virologic failure with targeted non-B subtype-based point-of-care resistance assays and timely phasing out of resistance-inducing ART regimens is recommended.

Keywords: HIV-1; non-B subtypes; disease progression; resistance mutation; differential impact; systematic review; evidence.

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(Published: 4 July 2014)

Citation: Bhargava M et al. Journal of the International AIDS Society 2014, 17:18944

http://www.jiasociety.org/index.php/jias/article/view/18944 | http://dx.doi.org/10.7448/IAS.17.1.18944




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