Monitoring HIV-1 Group M in the Asia-Pacific

Abstract

The Asia-Pacific is home to more than 60% of the world‘s inhabitants and the region second hardest hit by the effects of the HIV-1 pandemic, next to Sub-Saharan Africa. Many countries are low- or middle-income economies where a limited number of standardised antiretroviral therapies (ARTs) are available to treat HIV-infected patients. In resource-limited settings, viral load (VL) monitoring is not generally available to evaluate the effects of treatment. Furthermore, information is lacking as to the appropriate frequencies of VL monitoring to partner with ART. With suboptimal VL monitoring, virological breakthrough may be detected late, facilitating the accumulation of drug resistance-associated mutations (RAMs). Transmitted drug resistance would threaten already limited treatment options in the region. Viral diversity in HIV-1 epidemics is increasing. Predominant regional genotypes are subtypes B and C, CRF01_AE and their recombinants.Objectives were to contribute to efforts to monitor regional HIV-1. I evaluated impacts of diagnostic resourcing on patient treatment outcomes and provided estimates of transmitted HIV drug resistance (HIVDR). Associations between sexual exposures and HIV-1 genotype were evaluated, as were relationships between genotype and patient treatment outcomes.Analysis outcomes spanned the years 2000–2010 and included patients from Cambodia, mainland China and Hong Kong, India, Indonesia, Japan, Malaysia, Papua New Guinea, the Philippines, Singapore, South Korea, Taiwan and Thailand.Findings indicated that less-than-annual site-reported VL testing was associated with poorer treatment outcomes, including a 35% increased risk of acquired immunodeficiency syndrome (AIDS) or death. The prevalence of RAMs in our treatment-naïve patients from any drug class was 13.8%. Predominant HIV-1 genotypes were CRF01_AE and subtype B. Males and patients reporting HIV exposure as homosexual contact had a higher odds of being infected with subtype B. I found that treatment-naïve patients infected with CRF01_AE had lower changes in CD4 counts 12 months post-therapy.Results suggest the need for appropriate monitoring of VL, to improve patient treatment outcomes, and of HIVDR, to inform of risks to standardised regimen efficacy. Genotype tracking of regional variants will help to identify increasing incidence of HIV-1 genotypes in at-risk groups and contribute to monitoring HIV-1 diversity and proliferation in the region