1 / 17

HIV Drug Resistance Control: the Latin American experience

HIV Drug Resistance Control: the Latin American experience. Giovanni Ravasi Pan-American Health Organization, Brazil ravasigi@paho.org International AIDS Conference, Washington D.C, 22 July 2012 HIV Drug Resistance Surveillance and Control: A Global Concern.

landen
Download Presentation

HIV Drug Resistance Control: the Latin American experience

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. HIV Drug Resistance Control: the Latin American experience Giovanni Ravasi Pan-American Health Organization, Brazil ravasigi@paho.org International AIDS Conference, Washington D.C, 22 July 2012 HIV Drug Resistance Surveillance and Control: A Global Concern

  2. Antiretroviral treatment in Latin America and the Caribbean “Antiretroviral Treatment in the Spotlight” • 521.000 people under ART - 63% regional coverage (Dec 2010) • 72,6% (1st line), 23,7% (2nd), 3,7% (3rd). • 63% of 1st line and 33% of 2nd regimens consistent with WHO. 63% 33%

  3. PAHO HIV Drug Resistance Strategy WHO HIVDR strategy introduced in the Caribbean in 2006 and Latin America in 2007. Technical cooperation provided to 30 countries (13 Latin America/17 Caribbean) for the development of HIVDR prevention and assessment strategies in 2008-2012. Key elements in Latin America and Caribbean: • Early Warning Indicators (EWI) • HIVDR surveillance and monitoring • Transmitted Drug Resistance (TDR) systematic review

  4. 1. HIVDR Early Warning Indicators • 24 countries reported EWIs (2010-2011): 8 LA/ 16 CAR • Regional EWI summary results published in 2011/2012.

  5. 2. HIVDR Surveillance and Monitoring HIVDR Surveillance: • Mexico (2004) - Bertagnolio et al • Brazil (2007-2008) - Inocencio et al - adapted* • Panama (2008-2010) - Castillo et al - adapted* * Genotyping not performed in WHO accredited labs. HIVDR Monitoring: • Haiti – ongoing • Guyana – ongoing

  6. Transmitted Drug Resistance (TDR) in Latin America Frentz et al. AIDS Rev. 2012 • 26 studies (3.218 patients) with sampling time 1993-2008. TDR Prevalence Any class: 6,3% (5,5-7,3%) NRTI: 3,8% (3,2 – 4,6%) NNRTI: 1,6 (1,2-2,1) PI: 2,4 (2,0 – 2,8%) Time trends (<2001 - >2003): NRTI decreased 6,6 to 2,8% (p<0,001) NNRTI increased 0,6 – 2,7 (p<0,001) PI increased 1,6 to 2,7% (p=0,01)

  7. 3. TDR systematic review Literature abstraction • 75 publications (56 articles and 19 abstracts)published between Jan 2000/Feb 2012 (11.194 individuals) • 79 surveys in Latin America and Caribbean • 87 drug resistance results: - 74 (85%) DR in chronically infected individuals • 13 (15%) TDR in recently infected individuals Sources NCBI-NIH PubMed, NIH-NLM Gate Way, Embase, WHO Global Health Library, BIREME BVS, SciELO. Abstracts from CROI, IAS, IAC, HIVDR International Workshop.

  8. 3. TDR systematic review Subregional distribution of surveys • 39 (49%) Brazil • 16 (20%) Southern Cone - no data for Paraguay and Uruguay • 8 (10%) Andean Region - no data for Ecuador and Bolivia • 7 (9%) Central America - no data for Nicaragua and Costa Rica • 6 (8%) México • 3 (4%) Caribbean - only Dominican Republic and Cuba

  9. 3. TDR systematic review Population type 64 (81%) mixed population, 4 pregnant women, 3 blood donors 4 MSM, and others (2 IDU; 1 FSW; 1 army soldiers) HIV Genotyping method 40 (62%) In House, 13 (20%) Viroseq, 12 (18%) Trugene Reference for DR mutations WHO list (2007-2009) of TDR mutations used in 28% papers after 2007. Results have been revised according to WHO 2009 list. WHO TDR categories to classify results: Low <5%; moderate 5-15%; high >15%.

  10. Resistance to any ARV class

  11. Resistance to individual ARV classes

  12. Brazil Prevalence of TDR shows geographic specificities with areas of low, moderate and high resistance. .

  13. Multiple class drug resistance (MDR) • No evidence of MDR in the Caribbean. • Very limited evidence (<1%) of MDR in Southern Cone, Central America, Andean Region (recently infected), Brazil and Mexico TAMs (≥3 mutations) • No evidence in the Andean Region, Central America, Caribbean • Very limited evidence (<1%) in Southern Cone, Brazil and Mexico. K65R (TDF mutation) • No evidence in the Andean Region, Southern Cone, Caribbean, Brazil and Mexico • In Central America: 1 sample with K65R only in 1 study in 2003.

  14. Common methodological limitations • Convenience sampling (or no sample size calculation presented). • Small sample size (<47- 54% surveys in recently / 22% in chronically infected subjects). • Long sampling time periods (>3 years in 24%; max 7 years) • Different survey populations (recently infected, recently diagnosed, pre-ART). • Different definitions of “recently infected”. • Different TDR mutation lists (IAS, Stanford, WHO, ANRS, etc.).

  15. Conclusions (1) - Prevalence and patterns of TDR vary across subregions. - HIVDR surveillance should be expanded. • Standardized and representative methodology. • Generic protocols for HIVDR surveillance (countries with low HIV prevalence; MARPs). • Full scale national HIVDR surveillance (TDR/pre-ART) when confirmed evidence of moderate resistance. - Use of HIVDR data for public health actions is a challenge. • Guidance for interpretation and programmatic use of HIVDR surveillance data is needed to support National Programs (especially in case of moderate-high resistance).

  16. Conclusions (2) Is important to strengthen HIVDR prevention • HIVDR prevention activities should be supported and strengthened at country level (EWIs, Treatment 2.0 and optimization, stock-out surveillance, prevention for positives, etc.). More operational research is needed • Support operational research on impact of low/moderate single class/multiple class TDR on first line effectiveness.

  17. PAHO HIV ProjectMassimo GhidinelliOmar SuedMonica AlonsoNoreen JackAmalia del RiegoBertha GomezMaria Dolores Perez-RosalesMarcelo VilaAll country based HIV Focal points WHO/HQ HIVDR teamSilvia BertagnolioDiane BennettMichael Jordan Acknowledgments Thankyou Gracias Obrigado Merci

More Related